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Propofol requirements for induction of anesthesia in children of different age groups
H J Manschot1, A E Meursing, P Axt
1Department of Anesthesia, Erasmus University (Division of Pediatric Anesthesia), Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
This study found that a propofol dose of 2.5 mg/kg, preceded by alfentanil, is effective for inducing anesthesia in children aged 3-15. Older children required lower doses of propofol to fall asleep.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pharmacology
Background:
- Propofol is a common anesthetic induction agent.
- Determining optimal pediatric dosing is crucial for safe and effective anesthesia.
- Age-related variations in anesthetic requirements are known but require specific investigation for propofol.
Purpose of the Study:
- To investigate age-related differences in propofol requirements for anesthesia induction in children.
- To establish an appropriate propofol induction dose for healthy children aged 3-15 years.
- To evaluate the efficacy and safety of alfentanil premedication for reducing injection pain.
Main Methods:
- 150 healthy children (3-15 years) were randomized into age groups (3-5, 6-9, 10-15 years).
- Children received varying induction doses of propofol (1.5-3.5 mg/kg) after alfentanil (5 µg/kg) premedication.
- Anesthesia induction success, injection pain, excitation, apnea, blood pressure, and heart rate were assessed.
Main Results:
- Over 95% of children achieved anesthesia with propofol doses ≥ 2.5 mg/kg.
- A significantly greater number of older children fell asleep with a lower propofol dose (1.5 mg/kg).
- Apnea incidence increased with age and higher propofol doses; erythema was dose-dependent.
Conclusions:
- A propofol induction dose of 2.5 mg/kg, with alfentanil premedication, is appropriate for children aged 3-15 years.
- Older children demonstrate an enhanced sedative response to lower propofol doses.
- Alfentanil effectively mitigates injection pain during propofol administration.
Abstract:
To demonstrate any age-related differences in propofol requirements for induction of anesthesia, 150 healthy children aged 3-5 yr (n = 50), 6-9 yr (n = 50), and 10-15 yr (n = 50) scheduled for outpatient surgery were randomly assigned to receive an induction dose of propofol of 1.5, 2.0, 2.5, 3.0, or 3.5 mg/kg. To limit pain during injection, alfentanil (5 micrograms/kg) was administered before the propofol. Patients were classified as asleep or not asleep 30 s after the propofol. Incidence of excitation, injection pain, and apnea during induction of anesthesia were noted; arterial blood pressure and heart rate were recorded for 5 min after induction. More than 95% of the children were asleep in the dose groups receiving > or = 2.5 mg/kg. The number of patients falling asleep after receiving 1.5 mg/kg of propofol increased significantly with increasing age (P < 0.05); the difference between the oldest and the youngest age groups was the most significant (P < 0.05). Significant decreases in mean arterial blood pressure and heart rate occurred after induction in all dose and age groups without any systematic intergroup differences. Apnea occurred more frequently in older children (P < 0.01) and with larger doses (P < 0.01). The most frequent side effect was erythema near the site of injection, and its occurrence was dose dependent. The authors conclude that 2.5 mg/kg of propofol, if preceded by 5 micrograms/kg of alfentanil, is an appropriate induction dose for children aged 3-15 yr and that the sleep response to 1.5 mg/kg is more in older children.