Changes in respiratory and hemodynamic parameters during low-dose propofol sedation in combination with regional anesthesia for herniorrhaphy and genitourinary surgery in children.
BACKGROUND
Spontaneous vs mechanical ventilation during propofol sedation has been a subject of debate. We evaluated the safety of low-dose propofol sedation as an adjunct to regional anesthesia during herniorrhaphy and genitourinary surgery in infants and children.


METHODS
The study was conducted in a prospective, nonrandomized manner using a consecutive sample of 62 American Society of Anesthesiologists physical status class I patients between 5 months to 11 years of age in the surgery unit of an urban University Hospital. Propofol sedation (4-8 mg x kg(-1) x h(-1) continuous infusion) was used with regional anesthesia (caudal, ilioinguinal/iliohypogastric nerve or penile block with 0.2-0.375% ropivacaine). All children were spontaneously breathing without an anesthesia circuit. Respiratory and hemodynamic parameters were continuously recorded on all patients. One-way analysis of variance (ANOVA) for repeated measurements was used to analyze changes in respiratory and hemodynamic parameters during the procedure.


RESULTS
Spontaneous ventilation was maintained in all patients with minimal changes in hemodynamic parameters. Heart rate, mean arterial pressure, and P(E)CO(2) remained stable throughout the study period: 23/62 (37%) patients exhibited signs of developing intrinsic endexpiratory pressure (PEEPi) or the presence of PEEPi because of progressive reduction of expiratory time.


CONCLUSIONS
Low-dose propofol sedation in combination with regional anesthesia for elective herniorrhaphy and genitourinary surgery in children maintains spontaneous ventilation and has minimal effects on hemodynamic parameters for sedation lasting <1 h. The presence of PEEPi is a relative contraindication to the use of this regimen in children with asthma or history of upper airway infections.
Zanaboni
Silvio
S
Anesthesiology and Intensive Care Unit, Università del Piemonte Orientale, Novara, Italy. vanished3@libero.it
Krauss
Baruch
B
Buscaglia
Raffaella
R
Montagnini
Claudia
C
Gratarola
Angelo
A
Gualino
Jenny
J
Colombo
Roberto
R
Della Corte
Francesco
F
D000765:Anesthesia, Conduction; D018686:Anesthetics, Intravenous; D001794:Blood Pressure / Q000187:drug effects*; D002248:Carbon Monoxide / Q000097:blood; D002648:Child; D002675:Child, Preschool; D002944:Circumcision, Male; D016292:Procedural Sedation; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods; D015742:Propofol; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects*; D013519:Urogenital Surgical Procedures
D018686:Anesthetics, Intravenous; D002248:Carbon Monoxide; D015742:Propofol