Abstract
We analyzed the impact of propofol administration during continuous sedation and analgesia on the nociceptive flexion reflex threshold (NFRT) and Bispectral Index (BIS) in ventilated children. We examined patients who received propofol before planned endotracheal suctioning. Patients were clinically assessed using the modified Face, Legs, Activity, Cry, Consolability (mFLACC) scale and COMFORT-B (Comfort Behavior) scale. We continuously recorded the NFRT and BIS. We recorded 23 propofol administrations in eight patients with an average age of 8.6 ± 3.5 years. The median (minimum-maximum) scores for the mFLACC scale and COMFORT-B scale were 0 (0–5) and 6 (6–17), respectively, before the bolus. The administration of a weight-adjusted propofol bolus of 1.03 ± 0.31 mg/kg resulted in an increase in NFRT and burst-suppression ratio; BIS and electromyogram values decreased. Changes from baseline (95% CI) after propofol bolus administration were BIS −23.9 (−30.8 to −17.1), EMG -10.5 dB (−13.3 to −7.7), SR 14.8 % (5.6 to 24.0) and NFRT 13.6 mA (5.5 to 21.7). Further studies are needed to determine whether sedated children may benefit from objective pain and sedation monitoring with BIS and NFRT.
Highlights
Ill children experience numerous stressful and potentially painful procedures during intensive care treatment [1]
The polysynaptic spinal nociceptive flexion reflex threshold (NFRT) is a technique that allows the estimation of the degree of analgesia [14]
We aimed to describe the impact of additional propofol bolus administration during continuous sedation and analgesia on the NFRT and Bispectral Index (BIS) in ventilated children
Summary
Ill children experience numerous stressful and potentially painful procedures during intensive care treatment [1]. In addition to continuous infusion for short-term sedation, it is used as a bolus administration for shortterm interventions, care facilitation, or extubation [2,3]. Propofol is frequently used in German intensive care units to facilitate stressful procedures in children, such as endotracheal suctioning [4]. There are no available data in the literature on the use of boluses of propofol in these indications for other countries. It is unclear how additional propofol bolus administrations during continuous sedation and analgesia impact pain reflex thresholds and electroencephalography (EEG) based sedation parameters in children
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