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To determine if age predicts dosing of propofol in children, investigators retrospectively reviewed records of 88 patients aged <18 years (mean age, 11 years) who received only propofol for procedural sedation at a single emergency department between 2005 and 2009.
Indications for sedation included fracture manipulation (60%), dislocation manipulation (17%), imaging (7%), and lumbar puncture (5%). The mean cumulative propofol dose was 2.1 mg/kg administered in a median of 3 boluses, with mean consecutive doses of 0.94, 0.49, and 0.40 mg/kg. Mean time to adequate sedation was 3.9 minutes. In linear regression analyses, age was inversely predictive of propofol dose; procedure type, opioid administration, and preprocedural pain scores were not predictors. Respiratory depression (oxygen saturation <90%, end tidal carbon dioxide >50 mm Hg or increase of >10 mm Hg from baseline, or apnea) occurred in 12 patients (14%); only 1 patient required temporary bag-mask ventilation. Transient hypotension occurred in 7 patients (8%) and required no intervention. Of note, although age was significantly inversely related to propofol dose, age accounted for only 7% of variability in doses.
Jasiak KD et al. Induction dose of propofol for pediatric patients undergoing procedural sedation in the emergency department. Pediatr Emerg Care 2012 May; 28:440.
Comment
The aim in propofol dosing is to select an initial dose that achieves prompt and adequate sedation while minimizing adverse events. Younger patients are more likely to require higher doses of propofol, but the initial dose requirement for any one patient cannot be perfectly predicted.