Propofol Use in Pediatric Sedations: Will a Lesser Dose be Effective? A Quality Improvement Project

Propofol provides sedation in the pediatric setting for imaging interventions, ensuring minimal movement from patients and high-quality pictures. Sanford Children's outpatient sedation clinic currently does not have a standard protocol for using propofol for sedation.

The study had three phases. The first phase was a 6-month retrospective chart review of propofol drip dose. The second phase introduced a goal propofol drip dose of 200-300 mcg/kg/min with reviewing success of sedation for 6 months. Lastly, the third phase introduced a goal propofol drip dose of 175-200 mcg/kg/min with reviewing success of sedation for 6 months. A successful sedation was determined by completing the imaging study without the child awakening.

The study was conducted at a pediatric outpatient center. A total of 181 patients ranging in ages 6 months to 16 years were recruited. Percentage of successful sedations in Phase 2 and Phase 3 were 83% and 84%, respectively. The average total propofol dose decreased from 15.43 mg/kg in the first part of the study to 12.31 mg/kg in the last phase. Lastly in the final phase, 44% of patients had a mean arterial pressure (MAP) below the normal range.

When evaluating the dose of propofol as a sedative for imaging intervention at Sanford Children's, a lower dose of propofol was 84% successful compared to a higher dose. Overall, we concluded that it is appropriate to create a sedation protocol with a target dose of 175-200 mcg/kg/min.