Propofol is a sedative-hypnotic agent approved for use in induction and maintenance of anesthesia or sedation in adult patients. Propofol use in pediatric ICUs has been hampered since Bray first described the occurrence of propofol related infusion syndrome (PRIS) in the 1980’s. The most common first reported signs of PRIS are new-onset metabolic acidosis and cardiac dysfunction. Serial lactate and CPK levels have been utilized as a screening tool. We report our institutional experience to support short term use of propofol to maintain sedation in mechanically ventilated pediatric patients. Retrospective chart review at a tertiary pediatric ICU. Patients receiving propofol infusion from January 2005 until September 2016 were reviewed. Patients receiving propofol for ICU sedation were included, procedural sedations patients were excluded. Propofol infusion is utilized in our pediatric ICU with the following precautions: 1.) Infusion rates less than or equal to 4 mg/kg/hr, duration should not exceed 72 hours. 2.) Infusion rates greater than 4 mg/kg/hr, duration should not exceed 48 hours. 3.) If duration of propofol therapy is to exceed these parameters, serial lactate levels and CPK levels are monitored. 4.) If lactate levels exceed normal values, propofol infusion should be discontinued. 208 patients - 45.7% females and 54.3% males. Age 9.91 years (SD 5.81). Admission diagnosis 13.9% respiratory, 25.5% neurological, 23.1% trauma, 4.3% cardiac, 11.5% surgical, 4.8% orthopedic, 5.3% ingestion, 2.4% sepsis, 1.4% burn, and 7.7% other uncategorized conditions. ECG was ordered in 10 and normal in 6. Mean time on propofol was 21.7 hours (SD 23.23) and the maximum time was 186 hours. Mean concentration was 1.8 mg/kg/hr (SD 1.17) and maximum 2.7 mg/kg/hr (SD 1.35). Propofol was combined with, 37% versed, 20.2% Ativan, 24.5% Precedex, 25.5% morphine, and 43.3% fentanyl. Ten patients had medical reasons to suspect CPK elevation before the propofol infusion - mean CPK 2335 units/L and under propofol maximum increase to 5716 units/L in 4 repeats. Initial lactic was tested in 90 patients and was 3.5 mmol/L (SD 3.40) before the infusion, and in 71, the maximum average repeat lactic was 2.7 mmol/L (SD 1.81). Initial BE was tested on 168 patients –2.8 mmol/L (SD 7.32) and average of the most negative repeats (184 patients) was –2.5 mmol/L (SD 5.42). BUN was 12.9 mg/dL (SD 10.01) in 182 patients and increased to 13.8 mg/dL (SD 14.06) in 148 repeats. Propofol was discontinued secondary to possible adverse effects in two patients. One developed an arrhythmia. The other was uremic with concern for rhabdomyolysis. Both patients improved without sequelae. Under close observation, propofol appears to be safe for pediatric critical care sedation. We intend to review more records and enhance the validity of our observations.
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Joint SOCC-PCCC Program| May 01 2018
(67) Propofol Sedation Safety Data
Anna Meredith Shaw, CPNP-AC;
Becky McGee Landman, DPh;
Pediatrics (2018) 142 (1_MeetingAbstract): 77.
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Anna Meredith Shaw, Becky McGee Landman, Thomas Spentzas; (67) Propofol Sedation Safety Data. Pediatrics May 2018; 142 (1_MeetingAbstract): 77. 10.1542/peds.142.1MA1.77
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