Issues in Propofol Sedation for Pediatric Patients Using Target Control Infusion (TCI): Safety in Children 1-3 Years Old Versus Children Older than 3 Years of Age

Tak Kyu Oh,Kyungho Kwon

doi:10.4172/2161-0665.1000291

Abstract

Purpose: Appropriate sedation is required when performing proton radiation therapy on pediatric patients. A target-controlled infusion (TCI) of propofol has recently been used for this purpose. However, there may be safety issues with the use of TCI in pediatric patients, as the initial bolus dose might be excessive for younger patients. To compare the safety and the incidence of adverse events between patients under and over 3 years of age undergoing sedation with a TCI (Paedfusor) model. Methods: We performed a retrospective observational study by analyzing the medical records of patients who underwent a computer tomography simulation prior to beginning proton radiation therapy between January 2013 and December 2014. Patients were divided into those 1-3 years of age and those > 3 years of age. The incidence of adverse events was tabulated. Results: Fifty-two patients-16 patients 1-3 years of age and 40 patients > 3 years of age-were included in the study. The adverse event incidence was the primary outcome. There was no statistically significant difference in desaturation (p = 0.231), nasopharyngeal airway insertion (p = 0.366), bradycardia (p = 1.000), and hypotension (p = 0.578). Additionally, there was no significant difference in sedation time, recovery time, propofol dose, and target concentration for induction or maintenance of anesthesia. Conclusions: The use of propofol TCI for the induction and maintenance of sedation did not show an increased risk of adverse events in pediatric patients 1-3 years of age versus patients > 3 years of age.

Highlights

When magnetic resonance imaging (MRI) or proton radiation therapy is performed on pediatric patients who are unable to cooperate, sedation is required
There was no significant difference in sedation time, recovery time, propofol dose, and target concentration for induction or maintenance of anesthesia
They concluded that most models overestimated the initial volume of distribution, and a larger than required initial bolus dose to reach the target concentration might be delivered [5] increasing the risk of adverse events

Summary

Introduction

When magnetic resonance imaging (MRI) or proton radiation therapy is performed on pediatric patients who are unable to cooperate, sedation is required. Sepúlveda et al studied the use of various pharmacokinetic models for propofol administration in 1-26 month old pediatric patients, and reported the safety of propofol TCI use in these patients [5]. They concluded that most models overestimated the initial volume of distribution, and a larger than required initial bolus dose to reach the target concentration might be delivered [5] increasing the risk of adverse events. Current data for the use of propofol sedation with TCI in pediatric patients less than 3 years of age is still lacking, and many clinicians in children’s’ hospitals still have concerns regarding the possibility of adverse events in these patients such as apnea, hypotension, and bradycardia. As a result, based on previous studies, using propofol TCI in patients under 3 years of age remains a challenge, since most pediatric TCI models have safety concerns regarding the large initial bolus required [4,5]

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Conclusion