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Induction dose-response of propofol in unpremedicated children
C S Aun1, S M Short, D H Leung
1Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories.
Insights
Propofol induction dose requirements varied significantly by age in Chinese children. Younger children (under 2 years) required higher doses for loss of eyelash reflex and mask acceptance compared to older children.
Area of Science:
- Anesthesiology
- Pediatric Pharmacology
- Clinical Dosing Studies
Background:
- Propofol is a widely used intravenous anesthetic agent for induction.
- Age-related differences in drug metabolism and response are common in pediatric populations.
- Understanding precise induction dose requirements is crucial for safe and effective anesthesia in children.
Purpose of the Study:
- To compare the propofol induction dose requirements across three distinct age groups of healthy Chinese children.
- To determine the effective dose 50 (ED50) and effective dose 95 (ED95) for loss of eyelash reflex and acceptance of face mask.
- To investigate the relationship between age and propofol dosage for anesthetic induction.
Main Methods:
- A randomized controlled trial involving 300 unpremedicated healthy Chinese children.
- Participants were divided into three age groups: <2 years (Group A), 2-5 years (Group B), and 6-12 years (Group C).
- Patients received one of eight randomized propofol doses (1.2-2.6 mg kg-1), and ED50/ED95 were calculated using probit analysis for loss of eyelash reflex and mask acceptance.
Main Results:
- Propofol ED50 and ED95 for both assessed endpoints were highest in the youngest group (A) and lowest in the oldest group (C).
- The ED95 for acceptance of face mask was 2.88 mg kg-1 in Group A, 2.53 mg kg-1 in Group B, and 2.20 mg kg-1 in Group C.
- Apnea incidence correlated with propofol dose, while pain on injection was not dose-dependent.
Conclusions:
- Age is a significant factor influencing propofol induction dose requirements in healthy Chinese children.
- Younger children (<2 years) necessitate higher propofol doses for effective induction compared to older children.
- These findings provide valuable data for optimizing propofol dosing strategies in pediatric anesthesia.
Abstract:
The induction dose requirements of propofol were compared in three age groups in 300 unpremedicated healthy Chinese children: group A, younger than 2 yr (n = 48); group B, 2-5 yr (n = 117); group C, 6-12 yr (n = 135). Patients in each group were allocated randomly to receive one of eight doses of propofol (1.2, 1.4, 1.6, 1.8, 2.0, 2.2, 2.4 and 2.6 mg kg-1). ED50 and ED95 for loss of eyelash reflex (LER) and acceptance of face mask (AFM) were determined using probit analysis. ED50 and ED95 for both LER and AFM were greatest in group A, less in B and smallest in C; ED95 (AFM) for groups A, B and C were 2.88 (2.55-3.36), 2.53 (2.31-2.86), and 2.20 (2.02-2.46) mg kg-1, respectively. This probably represented their effective induction dose. The incidence of apnoea was dose related, but not pain on injection.