Intra-individual propofol dosage variability in children undergoing repetitive procedural sedations

Objectives: Propofol sedation/anesthesia has been used successfully in children undergoing procedural sedation. We prospectively assessed intra- and inter-individual variability in propofol dosage for sedation in repetitive procedures in children with malignancies. Patients and methods: A total of 80 procedures including lumbar puncture, radiation therapy, magnetic resonance imaging, bone marrow biopsiy, endoscopy, drainage of ascites (range: 2–19 procedures/patient) were performed in 24 children (mean age: 9,6±5,4 years). The mean propofol induction dose was 2,61±0,74mg.kg-1 to achieve deep sedation. Primary outcome measure was the inter- and intra-individual propofol dosage required to achieve adequate sedation; secondary outcome measures were the number of adverse effects, the need for therapeutic interventions, and cardiovascular parameters. Results: All 80 procedures were completed with satisfactory sedation levels. There was a remarkable inter- and intra-individual variability in propofol dosage required to achieve adequate sedation (interindividual range 1.1–4.1mg.kg-1; intraindividual difference concerning the needed propofol induction 0.0–2.2mg.kg-1, 25% of the patients had a dose range of 0.0–0.5mg.kg-1, 37,5% >0.5–1.0mg.kg-1, 37,5% >1.0–2.2mg.kg-1. In 10% (n=8) of the procedures side effects were seen, mainly short episodes of desaturation which required no or only minor interventions. Conclusions: Due to great inter- and intra-individual differences, propofol dosage should be titrated towards the desired level of sedation. Thus propofol can be adjusted to the individual's need while achieving adequate sedation. Considering the substancial rate of adverse effects procedural sedation with propofol should be performed only by physicians experienced in advanced pediatric cardiorespiratory support.

Figure 1: Dose ranges in individual patients receiving repetitive propofol sedations