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Published on: January 13, 2018
Conscious sedation of children with propofol is anything but conscious
Scott T Reeves1, Jeana E Havidich, D Patrick Tobin
1Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA. reevess@musc.edu
Insights
Deep sedation, monitored by Bispectral (BIS) index, is necessary for pediatric bone marrow aspiration and intrathecal chemotherapy. Careful monitoring and preparedness are crucial due to potential risks associated with deep sedation.
Area of Science:
- Pediatric Anesthesiology
- Oncology Supportive Care
Background:
- Bone marrow aspiration and intrathecal chemotherapy are common pediatric procedures.
- Sedation is often required to ensure patient comfort and procedural success.
Purpose of the Study:
- To assess the depth of sedation needed for pediatric bone marrow aspiration and intrathecal chemotherapy.
- To correlate Bispectral (BIS) index values with clinical assessments during these procedures.
Main Methods:
- Sixteen children (23-190 months) undergoing 19 procedures were studied.
- Intravenous propofol was used for sedation.
- BIS index and clinical signs were monitored by an independent observer.
Main Results:
- Mean BIS score was 62.8, with a mean low of 29.7, indicating deep sedation or general anesthesia.
- Average propofol dose was 166 microg/kg/min.
- Clinical assessments showed depressed consciousness and impaired movement.
Conclusions:
- Pediatric patients undergoing these procedures require deep sedation, as evidenced by BIS values and clinical signs.
- Due to risks associated with deep sedation, informed consent, resuscitation equipment, and anesthesia personnel are essential.
Objective:
To determine the depth of sedation required for bone marrow aspiration and intrathecal injection of chemotherapeutic agents in children using a bispectral (BIS) index monitor and clinical assessment by an independent observer.
Methods:
Sixteen children who were undergoing 19 intrathecal chemotherapy and bone marrow aspirations were enrolled in the study. Their ages ranged from 23 months to 190 months with a mean of 79 months. The BIS index was recorded every 5 minutes by an independent observer. The patients received only intravenous propofol for sedation. There were no complications during the procedures.
Results:
The mean BIS score was 62.8+/- 9.6. The mean low BIS score was 29.7 +/- 13.7, indicating a level of deep sedation and/or general anesthesia was necessary to induce the desired stated of consciousness that would permit the practitioner to perform the procedure. The average dose of propofol was 166 +/- 47 microg/kg/min. Mean Aldrete score for level of consciousness was 0.9 +/- 0.4, indicating a depressed level of consciousness. The mean activity level was 1.0+/- 0.4, indicating impaired movement.
Conclusions:
Children who undergo conscious sedation with propofol for intrathecal chemotherapy and bone marrow aspiration demonstrate BIS values and clinical assessments consistent with deep sedation. Because of an increased risk of adverse events when children undergo deep sedation, appropriate parental informed consent, age-appropriate resuscitative equipment, and skilled anesthesia personnel should be present for rescue in the event of cardiovascular and respiratory complications from deep sedation.
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