Subscribe to RSS
Intermittent Bolus versus Continuous Infusion of Propofol for Deep Sedation during ABR/Nuclear Medicine Studies
23 November 2015
16 November 2016
30 December 2016 (online)
Objective A comparison of intermittent bolus (IB) versus continuous infusion of propofol for deep sedation.
Material and Methods A retrospective review of patients sedated for Auditory Brainstem Response (ABR)/nuclear medicine studies between September 2008 and February 2015. A ketamine bolus (0.5 mg/kg < 20 kg, 0.25 mg/kg > 20 kg) followed by propofol bolus of 1 mg/kg over 2 minutes. In the IB group, maintenance of deep sedation was with incremental bolus of 10 to 20 mg of propofol. In continuous infusion group (CG), maintenance was with a continuous infusion of 83 mcg/kg/min of propofol.
Results Of the 326 cases completed, 181 were in CG group and 145 were in IB group. There were no statistical differences in patient's age, weight, and American Society of Anesthesiologist (ASA) classification. The cardiovascular and respiratory parameters in the two groups were not different statistically. Mean total propofol dose was higher in CG group versus IB group (CG 7.6 mg ± 3.6 mg, IB 6.5 mg ± 3.6 mg; p = 0.008). Procedure time in CG group was longer by 8 minutes compared with IB group (CG 49.8 min ± 25.4 min versus 42.3 min ± 19.2 min; p = .003). CG group has both shorter recovery time (CG 8.1 min ± 4.7 min versus IB 10.0 min ± 8.5 min; p = 0.01) and discharge time.
Conclusion Satisfactory sedation and completion of the procedure was accomplished with both sedation protocols.
- 1 Deegan RJ. Propofol: a review of the pharmacology and applications of an intravenous anesthetic agent. Am J Med Sci 1992; 304 (01) 45-49
- 2 Shafer SL. Advances in propofol pharmacokinetics and pharmacodynamics. J Clin Anesth 1993; 5 (06) (Suppl. 01) 14S-21S
- 3 Struys M, Versichelen L, Thas O, Herregods L, Rolly G. Comparison of computer-controlled administration of propofol with two manually controlled infusion techniques. Anaesthesia 1997; 52 (01) 41-50
- 4 White PF. Propofol: pharmacokinetics and pharmacodynamics. Semin Anesth 1988; 1: 4-4
- 5 White PF. Clinical uses of intravenous anesthetic and analgesic infusions. Anesth Analg 1989; 68 (02) 161-171
- 6 American Society of Anesthesiologists. ASA task force on sedation and analgesia by non- anesthesiologists: practical guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96 (04) 1004-1017
- 7 Coté CJ, Wilson S. ; American Academy of Pediatrics; American Academy of Pediatric Dentistry; Work Group on Sedation. Guidelines for monitoring and management of pediatric patients during and after sedation for diagnostic and therapeutic procedures: an update. Pediatrics 2006; 118 (06) 2587-2602
- 8 Patel KN, Simon HK, Stockwell CA. , et al. Pediatric procedural sedation by a dedicated nonanesthesiology pediatric sedation service using propofol. Pediatr Emerg Care 2009; 25 (03) 133-138
- 9 Ramsay MAE, Savege TM, Simpson BRJ, Goodwin R. Controlled sedation with alphaxalone–alphadolone. BMJ 1974; 2 (5920): 656-659
- 10 Mathers LH, Frankel LR. Pediatric emergencies and resuscitation. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. , eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia: Elsevier; 2007: 387-404
- 11 Mason KP, Zurakowski D, Zgleszewski SE. , et al. High dose dexmedetomidine as the sole sedative for pediatric MRI. Paediatr Anaesth 2008; 18 (05) 403-411
- 12 Bennett J, Shafer DM, Efaw D, Goupil M. Incremental bolus versus a continuous infusion of propofol for deep sedation/general anesthesia during dentoalveolar surgery. J Oral Maxillofac Surg 1998; 56 (09) 1049-1053 , discussion 1053–1054
- 13 Machata AM, Willschke H, Kabon B, Kettner SC, Marhofer P. Propofol-based sedation regimen for infants and children undergoing ambulatory magnetic resonance imaging. Br J Anaesth 2008; 101 (02) 239-243
- 14 Kain ZN, Gaal DJ, Kain TS, Jaeger DD, Rimar S. A first-pass cost analysis of propofol versus barbiturates for children undergoing magnetic resonance imaging. Anesth Analg 1994; 79 (06) 1102-1106
- 15 Srinivasan M, Turmelle M, Depalma LM, Mao J, Carlson DW. Procedural sedation for diagnostic imaging in children by pediatric hospitalists using propofol: analysis of the nature, frequency, and predictors of adverse events and interventions. J Pediatr 2012; 160 (05) 801-806.e1
- 16 Voepel-Lewis T, Malviya S, Prochaska G, Tait AR. Sedation failures in children undergoing MRI and CT: is temperament a factor?. Paediatr Anaesth 2000; 10 (03) 319-323
- 17 Hasan RA, Shayevitz JR, Patel V. Deep sedation with propofol for children undergoing ambulatory magnetic resonance imaging of the brain: experience from a pediatric intensive care unit. Pediatr Crit Care Med 2003; 4 (04) 454-458
- 18 Burton JH, Harrah JD, Germann CA, Dillon DC. Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?. Acad Emerg Med 2006; 13 (05) 500-504
- 19 Campbell K, Torres L, Stayer S. Anesthesia and sedation outside the operating room. Anesthesiol Clin 2014; 32 (01) 25-43
- 20 Smith I, White PF, Nathanson M, Gouldson R. Propofol. An update on its clinical use. Anesthesiology 1994; 81 (04) 1005-1043
- 21 Short SM, Aun CS. Haemodynamic effects of propofol in children. Anaesthesia 1991; 46 (09) 783-785
- 22 Newson C, Joshi GP, Victory R, White PF. Comparison of propofol administration techniques for sedation during monitored anesthesia care. Anesth Analg 1995; 81 (03) 486-491
- 23 Hassan NE, Betz BW, Cole MR. , et al. Randomized controlled trial for intermittent versus continuous propofol sedation for pediatric brain and spine magnetic resonance imaging studies. Pediatr Crit Care Med 2011; 12 (06) e262-e265
- 24 Cravero JP, Blike GT, Beach M. , et al; Pediatric Sedation Research Consortium. Incidence and nature of adverse events during pediatric sedation/anesthesia for procedures outside the operating room: report from the Pediatric Sedation Research Consortium. Pediatrics 2006; 118 (03) 1087-1096