Propofol sedation by emergency physicians for elective pediatric outpatient procedures.
OBJECTIVE
We describe the efficacy of propofol sedation administered by pediatric emergency physicians to facilitate painful outpatient procedures.


METHODS
By using a protocol for patients receiving propofol sedation in an emergency department-affiliated short-stay unit, a prospective, consecutive case series was performed from January to September 2000. Patients were prescheduled, underwent a medical evaluation, and met fasting requirements. A sedation team was present throughout the procedure. All patients received supplemental oxygen. Sedation depth and vital signs were monitored while propofol was manually titrated to the desired level of sedation.


RESULTS
There were 291 separate sedation events in 87 patients. No patient had more than 1 sedation event per day. Median patient age was 6 years; 57% were male patients and 72% were oncology patients. Many children required more than 1 procedure per encounter. Most commonly performed procedures included lumbar puncture (43%), intrathecal chemotherapy administration (31%), bone marrow aspiration (19%), and bone biopsy (3%). Median total propofol dose was 3.5 mg/kg. Median systolic and diastolic blood pressures were lowered 22 mm Hg (range 0 to 65 mm Hg) and 21 mm Hg (range 0 to 62 mm Hg), respectively. Partial airway obstruction requiring brief jaw-thrust maneuver was noted for 4% of patient sedations, whereas transient apnea requiring bag-valve-mask ventilation occurred in 1% of patient sedations. All procedures were successfully completed. Median procedure duration was 13 minutes, median sedation duration was 22 minutes, and median total time in the short stay unit was 40 minutes.


CONCLUSIONS
Propofol sedation administered by emergency physicians safely facilitated short painful procedures in children under conditions studied, with rapid recovery.
Guenther
Elisabeth
E
Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City 84102, USA. elisabeth.guenther@hsc.utah.edu
Pribble
Charles G
CG
Junkins
Edward P
EP
Kadish
Howard A
HA
Bassett
Kathlene E
KE
Nelson
Douglas S
DS
D000759:Adjuvants, Anesthesia / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D001919:Bradycardia / Q000139:chemically induced; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D016292:Procedural Sedation / Q000379:methods* / Q000592:standards; D017558:Elective Surgical Procedures / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D007022:Hypotension / Q000139:chemically induced; D000860:Hypoxia / Q000139:chemically induced; D007223:Infant; D008297:Male; D010372:Pediatrics / Q000379:methods*; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects; D016896:Treatment Outcome; D014839:Vomiting / Q000139:chemically induced
D000759:Adjuvants, Anesthesia; D006993:Hypnotics and Sedatives; D005283:Fentanyl; D015742:Propofol