The Safe and Effective Use of Propofol Sedation in Children Undergoing Diagnostic and Therapeutic Procedures: Experience in a Pediatric ICU and a Review of the Literature

OBJECTIVES: To describe our experience using propofol sedation to facilitate elective diagnostic and therapeutic procedures, and to document the safety profile of propofol in this setting. DESIGN: Retrospective consecutive case series and review of the literature. SETTING: Pediatric intensive care unit of a United States Navy tertiary care medical center. PATIENTS: Children receiving propofol for procedural sedation over an 18-month period. OUTCOME MEASURES: Descriptive features of sedation including adverse events. RESULTS: During the study period, 91 children received propofol to facilitate the performance of 110 medical procedures. The mean induction dose was 2.41 mg/kg, the mean infusion rate was 179.3 microg/kg/min, and the mean total dose of propofol administered was 4.23 mg/kg. In all cases, sedation was successfully achieved. The average length of stay in the PICU was 108.4 minutes. Three children (3.3%) had transient episodes of oxygen desaturation that improved with repositioning of the airway. No child required placement of an endotracheal tube. Three (3.3%) children experienced hypotension requiring a decrease in the infusion rate of propofol and a 10-mL/kg bolus infusion of normal saline. No cardiac arrhythmias or adverse neurologic effects secondary to propofol infusion were identified. CONCLUSIONS: Pediatric intensivists can safely and effectively administer propofol to facilitate the performance of diagnostic and therapeutic procedures outside the operating room setting.