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Pediatric Radiology
Published in: Pediatric Radiology 8/2017

01-07-2017 | Original Article

Experience with the use of propofol for radiologic imaging in infants younger than 6 months of age

Authors: Elan Jenkins, Kiran B. Hebbar, Katie K. Karaga, Daniel A. Hirsh, James D. Fortenberry, Courtney E. McCracken, Stephen F. Simoneaux, Michael D. Mallory, Pradip P. Kamat

Published in: Pediatric Radiology | Issue 8/2017

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Abstract

Background

There is an increased risk associated with procedural sedation of infants younger than 6 months of age. The use of propofol for radiologic imaging of this age group is not well studied.

Objective

We hypothesize that adverse events are higher in the infant population receiving propofol for radiologic imaging.

Materials and methods

A retrospective chart review was undertaken of 304 infants younger than 6 months old who received propofol for procedural sedation from October 2012 to February 2015. Patient demographics, propofol dosing, sedation-related adverse events and interventions were collected. Serious adverse events were defined as laryngospasm, aspiration, the need for admission, cardiac arrest or death.

Results

Procedural sedation for radiologic imaging was successful in 301/304 (99%) of infants using propofol. Of these 304 patients, 130 (42.8%) patients were female, and 240 of the 304 (79%) were between 3 and 6 months of age. The majority of patients (172/304 [56.6%]) were American Society of Anesthesiologists-Physical Status Class II. There were 57 sedation-related, minor adverse events in 39 out of 304 (12.8%) patients. Thirteen of the 304 (4.3%) patients had 14 serious adverse events, with airway obstruction the most common. Eighty interventions were required in 56/304 (18.4%) patients. The most common interventions were continuous positive airway pressure (CPAP) in 25/304 patients (8.2%) and jaw thrust in 15/304 (4.9%). The median induction propofol dose was 4.7 mg/kg. A need for an increase in the propofol infusion rate during the procedure was noted in 162/304 (53.3%) infants. No significant predictors of sedation-related adverse events were detected.

Conclusion

Propofol can be used for radiologic imaging of infants younger than 6 months of age with a high success rate. Practitioners should be mindful of significantly higher dosing requirements and a higher incidence of airway events, which can be easily identified and managed by a team of experienced sedation providers.
Appendix
Available only for authorised users
Literature
1.
Cote CJ, Wilson S, American Academy of Pediatrics, American Academy of Pediatric Dentistry (2016) Guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures: update 2016. Pediatrics 138. doi:10.​1542/​peds.​2016-1212
2.
Couloures KG, Beach M, Cravero JP et al (2011) Impact of provider specialty on pediatric procedural sedation complication rates. Pediatrics 127:e1154–1160 3.
3.
Cravero JP (2012) Pediatric sedation with propofol-continuing evolution of procedural sedation practice. J Pediatr 160:714–716CrossRefPubMed
4.
Berkenbosch JW (2015) Options and considerations for procedural sedation in pediatric imaging. Paediatr Drugs 17:385–399CrossRefPubMed
5.
Tan G, Irwin MG (2010) Recent advances in using propofol by non-anesthesiologists. F1000 Med Rep 2:79
6.
Cravero JP (2009) Risk and safety of pediatric sedation/anesthesia for procedures outside the operating room. Curr Opin Anaesthesiol 22:509–513CrossRefPubMed
7.
Kamat PP, McCracken CE, Gillespie SE et al (2014) Pediatric critical care physician-administered procedural sedation using propofol: A report from the Pediatric Sedation Research Consortium Database. Pediatr Crit Care Med 16:11–208CrossRef
8.
Mallory MD, Baxter AL, Yanosky DJ et al (2011) Emergency physician-administered propofol sedation: a report on 25,433 sedations from the pediatric sedation research consortium. Ann Emerg Med 57:462–468CrossRefPubMed
9.
Monroe KK, Beach M, Reindel R et al (2013) Analysis of procedural sedation provided by pediatricians. Pediatr Int 55:17–23CrossRefPubMed
10.
Vespasiano M, Finkelstein M, Kurachek S (2007) Propofol sedation: intensivists' experience with 7304 cases in a children's hospital. Pediatrics 120:e1411–e1417CrossRefPubMed
11.
Shariat M, Mertens L, Seed M et al (2015) Utility of feed-and-sleep cardiovascular magnetic resonance in young infants with complex cardiovascular disease. Pediatr Cardiol 36:809–812CrossRefPubMed
12.
Windram J, Grosse-Wortmann L, Shariat M et al (2012) Cardiovascular MRI without sedation or general anesthesia using a feed-and-sleep technique in neonates and infants. Pediatr Radiol 42:183–187CrossRefPubMed
13.
Haney B, Reavey D, Atchison L et al (2010) Magnetic resonance imaging studies without sedation in the neonatal intensive care unit: safe and efficient. J Perinat Neonatal Nurs 24:256–266CrossRefPubMed
14.
Stokowski LA (2005) Ensuring safety for infants undergoing magnetic resonance imaging. Adv Neonatal Care 5:14–27
15.
Daud YN, Carlson DW (2014) Pediatric sedation. Pediatr Clin N Am 61:703–717CrossRef
16.
Godwin SA, Burton JH, Gerardo CJ et al (2014) Clinical policy: procedural sedation and analgesia in the emergency department. Ann Emerg Med 63(247–258):e218
17.
Ferrari LR (ed) (2012) The pediatric airway: anatomy, challenges, and solutions. Springer Science+Business Media, LLC, New York
18.
19.
Cote CJ, Zaslavsky A, Downes JJ et al (1995) Postoperative apnea in former preterm infants after inguinal herniorrhaphy. A combined analysis. Anesthesiology 82:809–822
20.
Green SM, Roback MG, Kennedy RM et al (2011) Clinical practice guideline for emergency department ketamine dissociative sedation: 2011 update. Ann Emerg Med 57:449–461CrossRefPubMed
21.
Grunwell JR, Marupudi NK, Gupta RV et al (2016) Outcomes following implementation of a pediatric procedural sedation guide for referral to general anesthesia for magnetic resonance imaging studies. Paediatr Anaesth 26:628–636CrossRefPubMedPubMedCentral
22.
Cravero JP, Beach ML, Blike GT et al (2009) The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the pediatric sedation research consortium. Anesth Analg 108:795–804
23.
Bhatt M, Kennedy RM, Osmond MH et al (2009) Consensus-based recommendations for standardizing terminology and reporting adverse events for emergency department procedural sedation and analgesia in children. Ann Emerg Med 53:426–435 e424
24.
Shaffer TH, Wolfson MR, Panitch HB (2004) Airway structure, function and development in health and disease. Paediatr Anaesth 14:3–14CrossRefPubMed
25.
Wheeler M, Cote CJ, Todres ID (2009) The pediatric airway. In: Cote CJ, Lerman J, Todres ID (eds) A practice of anesthesia for infants and children, 4th edn. Saunders-Elsevier, Philadelphia
26.
27.
Havidich JE, Beach M, Dierdorf SF et al (2016) Preterm versus term children: analysis of sedation/anesthesia adverse events and longitudinal risk. Pediatrics 137:e20150463CrossRefPubMed
28.
29.
30.
31.
Grunwell JR, McCracken C, Fortenberry J et al (2014) Risk factors leading to failed procedural sedation in children outside the operating room. Pediatr Emerg Care 30:381–387CrossRefPubMed
32.
Emrath ET, Stockwell JA, McCracken CE et al (2014) Provision of deep procedural sedation by a pediatric sedation team at a freestanding imaging center. Pediatr Radiol 44:1020–1025CrossRefPubMed
33.
Srinivasan M, Turmelle M, Depalma LM et al (2012) Procedural sedation for diagnostic imaging in children by pediatric hospitalists using propofol: analysis of the nature, frequency, and predictors of adverse events and interventions. J Pediatr 160:801–806 e801.
34.
Young TP, Lim JJ, Kim TY et al (2014) Pediatric procedural sedation with propofol using a higher initial bolus dose. Pediatr Emerg Care 30:689–693CrossRefPubMed
35.
Hassan NE, Betz BW, Cole MR et al (2011) Randomized controlled trial for intermittent versus continuous propofol sedation for pediatric brain and spine magnetic resonance imaging studies. Pediatr Crit Care Med 12:e262–e265CrossRefPubMed
36.
McFarlan CS, Anderson BJ, Short TG (1999) The use of propofol infusions in paediatric anaesthesia: a practical guide. Paediatr Anaesth 9:209–216PubMed
37.
Allegaert K, de Hoon J, Verbesselt R et al (2007) Maturational pharmacokinetics of single intravenous bolus of propofol. Paediatr Anaesth 17:1028–1034CrossRefPubMed
38.
39.
Parke TJ, Stevens JE, Rice AS et al (1992) Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. BMJ 305:613–616CrossRefPubMedPubMedCentral
40.
41.
Vasile B, Rasulo F, Candiani A, Latronico N (2003) The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Med 29:1417–1425CrossRefPubMed
42.
Farag E, Deboer G, Cohen BH, Niezgoda J (2005) Metabolic acidosis due to propofol infusion. Anesthesiology 102:697–698
43.
Metadata
Title
Experience with the use of propofol for radiologic imaging in infants younger than 6 months of age
Authors
Elan Jenkins
Kiran B. Hebbar
Katie K. Karaga
Daniel A. Hirsh
James D. Fortenberry
Courtney E. McCracken
Stephen F. Simoneaux
Michael D. Mallory
Pradip P. Kamat
Publication date
01-07-2017
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 8/2017
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-017-3844-7

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