Comparison of intermittent versus continuous infusion of propofol for elective oncology procedures in children.
OBJECTIVE
To compare the effects of administering propofol as a continuous infusion vs. bolus dosing in children undergoing ambulatory oncologic procedures in the pediatric intensive care unit (PICU).


METHODS
Prospective, randomized study.


METHODS
Tertiary PICU in a university hospital.


METHODS
Ambulatory oncology patients scheduled for diagnostic or therapeutic procedures with propofol anesthesia in the PICU were eligible for enrollment.


METHODS
Patients were randomly assigned to receive either continuous infusion or bolus administration of propofol in a protocol-driven manner. All patients received an initial bolus of 1.5 mg/kg, with additional 0.5 mg/kg doses until complete induction. Continuous infusions were started at 0.1 mg/kg/min and, if needed, increased 20% after a bolus of 0.5 mg/kg. Bolus group patients were given doses of 0.5 mg/kg if needed. Ramsay scores of < 5 were used as criteria for additional dosing.


RESULTS
Eighteen patients undergoing 40 separate procedures were enrolled during the study period. Twenty procedures each were performed with continuous or bolus administration of propofol. No differences were present between groups in demographic characteristics, induction dose and time, procedure and recovery times, or adverse events. All patients had adequate anesthesia and favorable satisfaction scores. More boluses were needed in the bolus group (8.5 +/- 4.6 vs. 5.4 +/- 2.9; p < .05). Average systolic blood pressure decreased more in the continuous infusion group (26.4% +/- 12 vs. 19.3% +/- 10; p < .05). Total propofol dose was higher in the continuous infusion group (8.0 mg/kg +/- 3.8 vs. 5.7 mg/kg +/- 2.4; p < .05).


CONCLUSIONS
Both continuous and bolus administration of propofol provided conditions for conducting oncologic procedures that were satisfying to patients, their families, and physicians. Continuous infusions were associated with a larger total dose and greater decreases in systolic blood pressure. Physician preference is likely to dictate which method is used.
Klein
Scott M
SM
Division of Pediatric Critical Care and Pulmonary Medicine, Department of Pediatrics, Georgetown University Medical Center, Washington, DC 20007, USA.
Hauser
Gabriel J
GJ
Anderson
Barry D
BD
Shad
Aziza T
AT
Gootenberg
Joseph E
JE
Dalton
Heidi J
HJ
Hertzog
James H
JH
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001707:Biopsy, Needle; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007275:Injections, Intravenous; D015278:Intensive Care Units, Pediatric; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000188:drug therapy*; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D013129:Spinal Puncture; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous; D000970:Antineoplastic Agents; D015742:Propofol