title: Changes in respiratory and hemodynamic parameters during low-dose propofol sedation in combination with regional anesthesia for herniorrhaphy and genitourinary surgery in children.
abstract: 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.
authors.affiliation: Anesthesiology and Intensive Care Unit, Università del Piemonte Orientale, Novara, Italy. vanished3@libero.it
authors.forename: Silvio
authors.initials: S
authors.lastname: Zanaboni
authors.forename: Baruch
authors.initials: B
authors.lastname: Krauss
authors.forename: Raffaella
authors.initials: R
authors.lastname: Buscaglia
authors.forename: Claudia
authors.initials: C
authors.lastname: Montagnini
authors.forename: Angelo
authors.initials: A
authors.lastname: Gratarola
authors.forename: Jenny
authors.initials: J
authors.lastname: Gualino
authors.forename: Roberto
authors.initials: R
authors.lastname: Colombo
authors.forename: Francesco
authors.initials: F
authors.lastname: Della Corte
mesh_terms: 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
chemical_list: D018686:Anesthetics, Intravenous; D002248:Carbon Monoxide; D015742:Propofol