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Propofol Use in Pediatric Sedations: Will a Lesser Dose be Effective? A Quality Improvement Project
Mir H Ali1,2, Michael Vlach3, Ethan Leif3
1Sanford Children's Specialty Clinic, Sioux Falls, South Dakota.
Insights
A new protocol using a lower propofol drip rate (175-199 mcg/kg/min) achieved successful pediatric sedation for MRIs, reducing medication dosage while maintaining imaging quality.
Area of Science:
- Anesthesiology
- Pediatric Imaging
- Pharmacology
Background:
- Propofol is crucial for pediatric MRI sedation, enabling patient immobility and high-quality imaging.
- Sanford Children's currently lacks a standardized propofol sedation protocol for pediatric MRI procedures.
- Optimizing propofol dosage is essential to balance sedation efficacy and patient safety.
Purpose of the Study:
- To evaluate the feasibility of decreasing propofol dosage for pediatric MRI sedation.
- To establish a standard protocol for propofol administration in pediatric MRI.
Main Methods:
- A three-phase retrospective chart review was conducted.
- Phase 1: Reviewed existing propofol dosing (6 months).
- Phase 2: Implemented target drip dose of 200-300 mcg/kg/min (6 months).
- Phase 3: Implemented target drip dose of 175-200 mcg/kg/min (4 months).
- Sedation success was defined as completing the MRI without patient awakening.
Main Results:
- 181 pediatric patients (6 months-16 years) were included.
- Successful sedation rates were 83% in Phase 2 and 84% in Phase 3.
- Average total propofol dose decreased from 15.43 mg/kg (Phase 1) to 12.31 mg/kg (Phase 3).
- Mean arterial pressure (MAP) was below normal in 60% of all sedations.
Conclusions:
- A protocol with a propofol drip rate of 175-199 mcg/kg/min ensures successful pediatric sedation for MRIs.
- This optimized dosage prevents excessive propofol administration.
- Further research into MAP trends during sedation is warranted.
Background:
Propofol provides sedation in the pediatric setting for MRIs, 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 purpose of the project was to determine if we could decrease the dose of propofol while maintaining adequate sedation during MRI imaging.
Methods:
The study had three phases of retrospective chart review. The first phase was a six-month review of propofol dosing. The second phase introduced a goal propofol drip dose of 200-300 mcg/kg/min with reviewing success of sedation for six months. Lastly, the third phase introduced a goal propofol drip dose of 175-200 mcg/kg/min with reviewing success of sedation for four months. A successful sedation was determined by completing the imaging study without the child awakening.
Results:
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 percent and 84 percent, respectively. The average total propofol dose used in sedations decreased from 15.43 mg/kg in phase 1 to 12.31 mg/kg in phase 3. On average of the three phases, the mean arterial pressure (MAP) overall was below the normal range in 60 percent of sedations.
Conclusion:
We conclude that creating a protocol with a baseline propofol drip rate of 175-199 mcg/kg/min for pediatric sedations would allow for successful sedations and prevent unnecessary excess dosing.
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