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Experience with the use of propofol for radiologic imaging in infants younger than 6 months of age

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Abstract

Background

There is an increased risk associated with procedural sedation of infants younger than 6 months of age. The use of propofol for radiologic imaging of this age group is not well studied.

Objective

We hypothesize that adverse events are higher in the infant population receiving propofol for radiologic imaging.

Materials and methods

A retrospective chart review was undertaken of 304 infants younger than 6 months old who received propofol for procedural sedation from October 2012 to February 2015. Patient demographics, propofol dosing, sedation-related adverse events and interventions were collected. Serious adverse events were defined as laryngospasm, aspiration, the need for admission, cardiac arrest or death.

Results

Procedural sedation for radiologic imaging was successful in 301/304 (99%) of infants using propofol. Of these 304 patients, 130 (42.8%) patients were female, and 240 of the 304 (79%) were between 3 and 6 months of age. The majority of patients (172/304 [56.6%]) were American Society of Anesthesiologists-Physical Status Class II. There were 57 sedation-related, minor adverse events in 39 out of 304 (12.8%) patients. Thirteen of the 304 (4.3%) patients had 14 serious adverse events, with airway obstruction the most common. Eighty interventions were required in 56/304 (18.4%) patients. The most common interventions were continuous positive airway pressure (CPAP) in 25/304 patients (8.2%) and jaw thrust in 15/304 (4.9%). The median induction propofol dose was 4.7 mg/kg. A need for an increase in the propofol infusion rate during the procedure was noted in 162/304 (53.3%) infants. No significant predictors of sedation-related adverse events were detected.

Conclusion

Propofol can be used for radiologic imaging of infants younger than 6 months of age with a high success rate. Practitioners should be mindful of significantly higher dosing requirements and a higher incidence of airway events, which can be easily identified and managed by a team of experienced sedation providers.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA, 30322, USA

    Elan Jenkins, Kiran B. Hebbar, James D. Fortenberry, Courtney E. McCracken, Stephen F. Simoneaux & Pradip P. Kamat

  2. Children’s Healthcare of Atlanta at Egleston, Atlanta, GA, USA

    Kiran B. Hebbar, Katie K. Karaga, James D. Fortenberry, Stephen F. Simoneaux, Michael D. Mallory & Pradip P. Kamat

  3. Division of Pediatric Critical Care Medicine, Children’s Healthcare of Atlanta at Egleston, Atlanta, GA, USA

    Kiran B. Hebbar, James D. Fortenberry & Pradip P. Kamat

  4. Pediatric Emergency Medicine Associates, Children’s Healthcare of Atlanta at Scottish Rite, Atlanta, GA, USA

    Daniel A. Hirsh & Michael D. Mallory

  5. Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA

    Stephen F. Simoneaux

Authors
  1. Elan Jenkins
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  2. Kiran B. Hebbar
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  9. Pradip P. Kamat
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Correspondence to Pradip P. Kamat.

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Appendix 1 American Society of Anesthesiologists-Physical Status (ASA-PS)

Appendix 1 American Society of Anesthesiologists-Physical Status (ASA-PS)

The American Society of Anesthesiologists’ physical status classification system is a subjective assessment of a patient’s overall health that is based on six classes (I to VI):

I. Patient is a completely healthy fit patient.

II. Patient has mild systemic disease.

III. Patient has severe systemic disease that is not incapacitating.

IV. Patient has incapacitating disease that is a constant threat to life.

V. Patient is moribund and not expected to live 24 h with or without surgery.

VI. Patient has been declared brain-dead and whose organs are being removed for donor purposes.

E. Emergency surgery, E is placed after the number.

From the American Society of Anesthesiologists’ physical status classification system. Available at http://www.asahq.org/~/media/sites/asahq/files/public/resources/standards-guidelines/asa-physical-status-classification-system.pdf

Accessed February 2015.

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Jenkins, E., Hebbar, K.B., Karaga, K.K. et al. Experience with the use of propofol for radiologic imaging in infants younger than 6 months of age. Pediatr Radiol 47, 974–983 (2017). https://doi.org/10.1007/s00247-017-3844-7

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  • DOI: https://doi.org/10.1007/s00247-017-3844-7

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