Abstract
BackgroundRadiation therapy requires the patient to remain immobile for a long time, which is challenging in children. This study therefore aimed to determine the adequate target concentration and dosage of propofol in target-controlled infusion (TCI) and manual infusion (MI) in children requiring sedation for proton radiation therapy. Our hypothesis is that the adequate dose of propofol sedation required for proton radiation therapy in pediatric patients was larger than that seen in previous studies.MethodsWe retrospectively analyzed the medical records of Korean children who received proton therapy under propofol sedation. The average target concentration at induction and during maintenance with TCI and the dose with MI were analyzed as primary outcomes.ResultsA total of 1296 procedures in 54 children were analyzed (TCI group, 26; MI group, 28). The median bolus dose of propofol in the MI group was 2.6 (2.2–3.0) mg/kg, while the pump speed was 17.0 (13.6–25.8) mg/kg/h. The median target concentration of propofol in the TCI group was 5.3 (4.4–5.7) mcg/mL at induction and 4.2 (3.1–5.1) mcg/mL during maintenance. There were no cases of life-threatening complications in either group over 7 years. There were six cases of transient desaturation, which were managed by using the jaw thrust maneuver.ConclusionsCompared with those in previous studies, the target concentration of propofol with TCI and the propofol dose with MI required for adequate sedation in children undergoing proton radiation therapy were larger in the present study. Despite concerns regarding overdosage, the complications were managed well. However, safe and adequate sedation for proton radiation therapy remains a challenge. The development of monitoring tools to evaluate the depth of sedation is necessary to adjust the propofol dose and sedation level.
Highlights
Radiation therapy requires the patient to remain immobile for a long time, which is challenging in children
From October 2011 to November 2013, sedation was performed with a targetcontrolled infusion (TCI) pump (Syramed uSP 6000, Acromed, Regensdorf, Switzerland) that was capable of TCI with the Paedfusor model, which is pharmacokinetically applicable to pediatric patients aged 1–15 years (Absalom et al 2003)
This retrospective observational study included a total of 1296 procedures and 54 pediatric patients who received proton therapy under propofol sedation with TCI (n = 26) or manual infusion (MI) (n = 28)
Summary
Radiation therapy requires the patient to remain immobile for a long time, which is challenging in children. This study aimed to determine the adequate target concentration and dosage of propofol in targetcontrolled infusion (TCI) and manual infusion (MI) in children requiring sedation for proton radiation therapy. Our hypothesis is that the adequate dose of propofol sedation required for proton radiation therapy in pediatric patients was larger than that seen in previous studies. Scheiber et al (1996) reported that a propofol loading dose of 3.6 ± 0.59 mg/ kg that was immediately followed by continuous infusion of 7.4 ± 2.2 mg/kg/h for maintenance was adequate and safe for deep sedation in children undergoing radiation therapy. Buehrer et al (2007) reported that a propofol loading dose of 3.7 mg/kg that was immediately followed by continuous infusion of 10 mg/kg/h did not cause problems in children undergoing proton therapy.
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