The purpose of this study was to determine the efficacy and safety of propofol sedation for pediatric procedures in the emergency department. For patients needing painful procedures, propofol was administered intravenously. Vital signs, complications, and time to recovery were recorded. Patient amnesia and parent, patient, and operator satisfaction with sedation were assessed. The mean age was 7.4 years; 65% were male. Most underwent fracture reduction. Mean total dose was 3.3 mg/kg. Thirty percent experienced desaturation. One required assisted ventilation. Most had decreases in blood pressure. Mean recovery time was 18 minutes. Satisfaction with sedation was rated “excellent.” Propofol was an effective sedation with minimal complications in the emergency department setting.
Get full access to this article
View all access options for this article.
References
1.
1. American Academy of Pediatrics, Committee on Drugs. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures (RE9252). Pediatrics. 1992;89:1110-1115.
2.
2. Schechter NL. The undertreatment of pain in children: an overview. Pediatr Clin North Am.1989;36:781-794.
3.
3. Petrack ER, Christopher NC, Kriwinsky J.Pain management in the emergency department: patterns of analgesic utilization. Pediatrics. 1997;99: 711-714.
4.
4. Hostetler MA, Szilagyi PG, Auinger A.Do children in the emergency department really receive less analgesia and sedation than adults?Acad Emerg Med.2000;7:549-549.
5.
5. Cote CJ. Sedation protocols-why so many variations?Pediatrics.1994:281-283.
6.
6. Baraff LJ. Conscious sedation of children. Ann Emerg Med.1996;24:1170-1172.
7.
7. Bauman LA, Kish I, Baumann RC, et al. Pediatric sedation with analgesia. Am J Emerg Med.1999;17:1-3.
8.
8. Broennle AM, Cohen DE. Pediatric anesthesia and sedation. Curr Opin Pediatr1993;5:310-314.
9.
9. Nelson DS, Hoagland JR, Kunkel NC. Costs of sedation using oral midazolam: money, time, and parental attitudes. Pediatr Emerg Care. 2000;16:80-84.
10.
10. Krauss B, Green SM. Sedation and analgesia for procedures in children. N Engl J Med.2000;342:938-945.
11.
11. Fulton B, Sorkin EM. Propofol. An overview of its pharmacology and a review of its clinical efficacy in intensive care sedation. Drugs.1995;50:636-657.
12.
12. Bryson HM, Fulton BR, Faulds D.Propofol. An update of its use in anesthesia and conscious sedation. Drugs.1995;50:513-559.
13.
13. Langley MS, Heel RC. Propofol: a review of its pharmocodynamic and pharmacokinetic properties and use as an intravenous anesthetic. Drugs.1988;35:334-372.
14.
14. Kain ZN, Gaal DJ, Kain TS, et al. A first-pass cost analysis of propofol versus barbiturates for children undergoing magnetic resonance imaging. Anesth Anaig.1994;79:1102-1106.
15.
15. Hertzog JH, Campbell JK, Dalton HJ, et al. Propofol anesthesia for invasive procedures in ambulatory and hospitalized children: experience in the pediatric intensive care unit. Pediatrics. 1999;103:e30-e30.
16.
16. Swanson ER, Seaburg DC, Stypula RW, et al. Propofol for conscious sedation: a case series. Acad Emerg Med.1995;2:661-663.
17.
17. Havel CJ Jr, Strait RT, Hennes H.A clinical trial of propofol versus midazolam for procedural sedation in a pediatric emergency department. Acad Emerg Med.1999;6:989-997.
18.
18. Hospital Policy and Procedure. Guidelines for sedation/analgesia for non-anesthesia providers for patients undergoing short term diagnostic and therapeutic procedures. Primary Children's Medical Center. 1998.
19.
19. Reisine T, Pasternak G.Opioid analgesics and antagonists. In: Goodman and Gilman's The Pharmacological Basis of Therapeutics, 7th ed.Gilman AG, et al, eds. New York: McGraw Hill; 1985, p. 543-543.
20.
20. Green SM, Nakamura R,Johnson NE. Ketamine sedation for pediatric procedures, Part 1: A prospective series. Acad Emerg Med.1990;19:1024-1032.
21.
21. Green SM, Johnson NE. Ketamine sedation for pediatric procedures, Part 2: Review and implications. Acad Emerg Med.1990;19:1033-1046.
22.
22. Sebel PS, Lawrence JD. Propofol: a new intravenous anesthetic. Anesth.1989;71:260-277.
23.
23. McLeskey CH, Walawander CA, Nahrwold ML, et al. Adverse events in a multicenter phase IV study of propofol: evaluation by anesthesiologists and postanesthesia care unit nurses. Anest Anaig.1993;77(Suppl 4):S3-S9.
24.
24. Hannallah RS, Baker SB, Casey W, et al. Propofol: effective dose and induction characteristics in unpremedicated children. Anesth.1991;74:217-219.
25.
25. Martin LD, Pasternak LR, Pudimat MA. Total intravenous anesthesia with propofol in pediatric patients outside the operating room. Anesth Anaig.1992;74:609-612.
26.
26. Aun CS, Short SM, Leung DH, et al. Induction dose-response of propofol in unpremedicated children. Br J Anaesth.1992;68:64-67.
27.
27. Newson C, Joshi GP, Victory R, et al. Comparison of propofol administration techniques for sedation during monitored anesthesia care. Anesth Anaig.1995;81:486-491.
28.
28. Short SM, Aun CS. Haemodynamic effects of propofol in children. Anaesthesia.1991;46:783-785.
29.
29. Hug CC Jr, McLeskey CH, Nahrwold ML, et al. Hemodynamic effects of propofol: data from over 25,000 patients. Anesth Ana Ig.1993;77(Suppl 4):S21-S29.
30.
30. Nathanson MH, Gajraj NM, Russell JA. Prevention of pain on injection of propofol: a comparison of lidocaine with Alfentanil. Anesth Anaig.1996;82:469-471.
31.
31. Parmar AK, Koay CK Pain on injection of propofol. A comparison of cold propofol with propofol premixed with Lignocaine. Anaesthesia.1998;53:79-83.
32.
32. Alyafi WA, Rangasami J.Reduction of propofol pain-fentanyl vs lidocaine. Middle East J Anesth.1996;13:613-619.
33.
33. Parker RI, Mahan RA, Giugliano D, et al. Efficacy and safety of intravenous midazolam and ketamine as sedation for therapeutic and diagnostic procedures in children. Pediatrics. 1997;99:427-431.
34.
34. Kennedy RM, Porter FL, Miller JP, et al. Comparison of fentanyl/midazolam with ketamine/midazolam for pediatric orthopedic emergencies. Pediatrics. 1998;102:956-963.
