Deep sedation with propofol by nonanesthesiologists: a prospective pediatric experience.
BACKGROUND
The need to perform procedural sedation for children has increased in recent years, and so has the experience of nonanesthesiologists in this field. The use of propofol increases the success of satisfactory deep sedation, but it can produce rapid and profound decreases in level of consciousness and cardiorespiratory function. Data are needed to assess the safety of this drug outside an anesthesiology setting.


OBJECTIVE
To assess safety and efficacy of procedural sedation with propofol in a pediatric ward of a tertiary-care pediatric teaching hospital with trained personnel and monitoring facilities.


METHODS
Patients admitted to the hospital who needed invasive procedures underwent procedural sedation by the pediatric sedation unit with intravenous propofol. A training protocol was developed to educate nurses and residents.


RESULTS
We performed 1059 procedures. Sedation was achieved in all procedures, and all but 1 were successfully performed. No patient required intubation. Transient desaturation resolving spontaneously occurred in 134 (12.7%) of 1059 patients. Major desaturation requiring a short course of ventilation occurred in 4 (0.8%) of 483 patients undergoing upper endoscopies, in 1 (0.3%) of 287 patients undergoing painful procedures, and in none of the 289 patients undergoing colonoscopies. Laryngospasm occurred in 10 (2.1%) of 483 patients undergoing upper endoscopies.


CONCLUSIONS
In this experience, the use of propofol with concurrent oxygen administration allowed sedations in children with no significant complications for colonoscopies and painful procedures. Complications in the group of upper endoscopies appear too high for recommending propofol in a sedation unit with residents in attendance. This protocol of procedural sedation by nonanesthesiologists allowed a significant increase in the number of procedures performed with sedation and saved anesthesiology resources.
Barbi
Egidio
E
Clinica Pediatrica, Servizio di Gastroenterologia, Istituto di Ricovero e Cura a Carattere Scientifico Burlo Garofolo, University of Trieste, Trieste, Italy. ebarbi@libero.it
Gerarduzzi
Tania
T
Marchetti
Federico
F
Neri
Elena
E
Verucci
Elena
E
Bruno
Irene
I
Martelossi
Stefano
S
Zanazzo
Giulio
G
Sarti
Armando
A
Ventura
Alessandro
A
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D005260:Female; D006776:Hospitals, Pediatric; D006784:Hospitals, Teaching; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008991:Monitoring, Physiologic; D010348:Patient Care Team / Q000458:organization & administration; D017060:Patient Satisfaction; D010372:Pediatrics; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D011795:Surveys and Questionnaires
D006993:Hypnotics and Sedatives; D015742:Propofol