What is the role of propofol in pediatric sedation?

Updated: May 08, 2018
  • Author: Wan-Tsu Wendy Chang, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Answer

Answer

Propofol

Propofol is a unique medication that has no relation to either of the usual sedative classes (ie, benzodiazepines and barbiturates). It is a purely sedative agent without any analgesic or amnestic properties.

Because of its high lipid solubility, propofol has a rapid onset of action (within 40 seconds). Its duration of action is 1-3 minutes, allowing swift emergence and recovery. Preliminary pediatric studies indicate that propofol is efficacious in terms of providing sedation and is easy to use.

Monitored anesthesia care (MAC) sedation dosing is 0.5-1 mg/kg by IV push, infused over 2 minutes initially. Maintenance dosing is 0.5-1 mg/kg IV every 3-5 minutes as needed or, alternatively, 50-150 µg/kg/min by continuous IV infusion.

Initially, propofol was used as an induction agent in general anesthesia. However, it has also been used for sedation in intubated patients in intensive care units (ICUs) and in patients undergoing diagnostic imaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI). Propofol is now an important sedation agent among ED physicians. Controversy exists among anesthesiologists and ED physicians regarding optimal use of this drug in patient management. [21]

Procedural sedation policy governing propofol use is typically under the direction of the anesthesiology department. Anesthesiologists have often opposed ED use of propofol because of the potential risk of deep sedation (leading to general anesthesia) and hypoxic/respiratory depression. However, emergency medicine physicians have the technical skills for rapid-sequence intubation and advanced airway management. The ED practice environment is tailor-made for propofol use in a brief controlled setting for procedural sedation. [22]

Increasing numbers of studies describe propofol use in the ED. Patel et al described how propofol provided effective moderate sedation for procedures lasting 30 minutes or longer and outlined effective dosing regimens in different age groups. [23] In this study, the sedation was performed by a pediatric sedation service staffed by nonanesthesiologists.


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