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Age-Stratified Propofol Dosage for Pediatric Procedural Sedation and Analgesia

Huib van Dijk1, Mark P Hendriks, Marga M van Eck-Smaling

  • 1From the Department of Anesthesiology, Division of Anesthesiology, Intensive Care and Emergency Medicine, UMC Utrecht, Utrecht, the Netherlands.

Anesthesia and Analgesia
|September 22, 2022
PubMed

Insights

Pediatric procedural sedation requires lower propofol doses with increasing age. Infants and toddlers needed higher propofol sedation doses than anticipated.

Area of Science:

  • Anesthesiology
  • Pediatric Sedation
  • Pharmacology

Background:

  • Procedural sedation and analgesia (PSA) is common in pediatric patients.
  • Clinical experience suggested an inverse relationship between patient age and propofol dosage.
  • A standardized age-stratified dosage schedule for PSA was lacking.

Purpose of the Study:

  • To investigate the age-dependency of propofol induction and maintenance dosages for pediatric procedural sedation.
  • To provide a reference schedule for anesthesiologists.

Main Methods:

  • Retrospective cohort study of 6438 pediatric procedures from June 2007 to December 2020.
  • Analysis of propofol induction (mg·kg -1 ) and maintenance (mg·kg -1 ·h -1 ) dosages.
  • Linear regression models adjusted for sex, ASA status, opioid use, and procedure type.

Main Results:

  • A significant inverse relationship was found between age and propofol dosage for both induction and maintenance.
  • Multivariable regression showed coefficients of -0.11 for induction and -0.36 for maintenance dosage per year of age.
  • Higher propofol doses were required for infants and toddlers than previously reported.

Conclusions:

  • An inverse age-effect on propofol dosage for pediatric procedural sedation was confirmed.
  • Infants and toddlers require higher propofol sedation doses than previously expected.
  • The findings support the development of age-stratified dosage guidelines.
Abstract

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