Intravenous anesthesia with propofol for painful procedures in children with cancer.
OBJECTIVE
To study the safety and efficacy of propofol-based intravenous anesthesia in children with cancer undergoing painful procedures.


METHODS
This study is a retrospective analysis of data collected from 52 consecutive children who underwent 335 procedures using propofol anesthesia. These data were routinely collected in all patients: time to induction, duration of the procedure, time to recover, and the doses of the drugs used. Monitoring with electrocardiography and pulse oximetry was continuous during the procedure; blood pressures were recorded before and after the procedure and every 5 to 10 minutes during the procedure. The patients received one of these four propofol-based intravenous regimens according to the anesthesiologist's preference: propofol only; propofol plus fentanyl; propofol plus midazolam; or propofol, fentanyl, and midazolam. The efficacy of sedation was rated by this scoring system: 3 = no movement during procedure; 2 = minimal movement that did not interfere with the procedure; 1 = moderate movement requiring physical restraint to complete the procedure.


RESULTS
There were six episodes of mild hypoxia (oxygen saturation 85%-94%) and one episode of laryngospasm. None required intubation. Two patients had agitation and one patient had emesis during the postrecovery phase. There was no difference in the efficacy of sedation between the four regimens. Patients receiving the combination of propofol, fentanyl, and midazolam received the least amount of propofol and required the least time to recover. There were no life-threatening complications.


CONCLUSIONS
Propofol-based anesthesia, when administered by an anesthesiologist in a controlled setting, is safe and effective for performing painful procedures in children with cancer.
Jayabose
S
S
Section of Pediatric Hematology-Oncology, New York Medical College, Valhalla 10595, USA. S_Jayabose@NYMC.edu
Levendoglu-Tugal
O
O
Giamelli
J
J
Grodin
W
W
Cohn
M
M
Sandoval
C
C
Ozkaynak
F
F
Kubal
K
K
Nosetti
M
M
Uman
J
J
Visintainer
P
P
D000553:Ambulatory Care; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000009:adverse effects*; D001856:Bone Marrow Examination / Q000009:adverse effects*; D002648:Child; D004341:Drug Evaluation; D004562:Electrocardiography; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use; D009369:Neoplasms / Q000150:complications*; D010092:Oximetry; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D015742:Propofol / Q000008:administration & dosage*; D011595:Psychomotor Agitation / Q000209:etiology; D012189:Retrospective Studies; D012449:Safety; D013129:Spinal Puncture / Q000009:adverse effects*
D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol