Wada testing in pediatric patients by use of propofol anesthesia

BACKGROUND AND PURPOSE: Wada testing may provide important information for surgical planning in pediatric patients with medically refractory epilepsy, but it is often not used because of the difficulties in performing the ang iographic portion of the procedure in conscious children. We reviewed our e xperience using propofol, a short-acting IV administered anesthetic agent, for pediatric patients undergoing Wada testing. METHODS: In a retrospective review of Wada tests performed on patients youn ger than 18 years, we identified 24 cases in which propofol anesthesia was used. We reviewed the medical records of these patients, with particular re ference to dose of propofol, physiological parameters during anesthesia, an d adequacy of neuropsychological testing after emergence from anesthesia. RESULTS: Patients ranged in age from 6 to 16 years (mean age, 12.5 years). Propofol induced mild reductions in blood pressure (12.4% for systolic and 13.9% for diastolic blood pressure) and heart rate (mean reduction of 4.7%) , which did not require specific treatment in any patient. Recovery from an esthesia was smooth and rapid, allowing initiation of Wada testing within 1 5 to 25 minutes of cessation of propofol. Wada testing was successfully acc omplished in all patients. CONCLUSION: Propofol provided rapid induction of anesthesia, was administer ed without endotracheal intubation, and did not cause substantial changes i n cardiorespiratory parameters, Propofol anesthesia allowed controlled angi ography among patients as young as 6 years and did not interfere with neuro psychological testing.