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Propofol Sedation Washouts in Critically Ill Infants: A Case Series
Stephen Deptola1, Brianna Hemmann1, Trina Hemmelgarn1
1Division of Pharmacy (SD, BH, TH, KD), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Propofol sedation washouts offer a safe and effective method for rapidly weaning medically complex infants off long-term opioids and benzodiazepines. This approach helps manage withdrawal symptoms and facilitates medication weaning when conventional methods fail.
Area of Science:
- Neonatalogy
- Pediatric Critical Care
- Pharmacology
Background:
- Medically complex infants often require prolonged analgesia and sedation with opioids and benzodiazepines.
- Rapid weaning of these medications can precipitate withdrawal symptoms and agitation.
- Conventional methods may be insufficient for managing complex sedation needs in infants.
Purpose of the Study:
- To describe the use of propofol for rapid weaning of high-dose sedation and analgesia in infants.
- To evaluate the safety and efficacy of propofol sedation washouts in this population.
- To provide recommendations for implementing propofol washouts in neonatal care.
Main Methods:
- Case series describing propofol sedation washout in 3 infants.
- Review of institutional experience and existing literature on propofol use in infants.
- Assessment of safety and efficacy based on clinical outcomes.
Main Results:
- Propofol sedation washouts were successfully used to rapidly wean infants from high-dose opioids and benzodiazepines.
- The procedure was found to be safe and efficacious in the studied infants.
- No significant adverse events were reported during the washouts.
Conclusions:
- Propofol sedation washout is a viable alternative for managing complex sedation and analgesia in infants.
- This method can facilitate the rapid weaning of sedative medications, reducing withdrawal risks.
- Further research and standardized protocols are warranted to support the broader use of propofol washouts in neonatal intensive care units.
Abstract:
Medically complex infants are experiencing longer hospital stays, more invasive procedures, and increasingly involved therapeutic interventions that often require long-term analgesia and sedation. This is most commonly achieved with continuous intravenous infusions of opioids and benzodiazepines. There are times when patients develop a tolerance for these medications or the clinical scenario necessitates a rapid wean of them. A rapid wean of either class of medication can lead to increased signs of pain and agitation or withdrawal symptoms. As a result, when a rapid wean is needed or there has been a failure to control symptoms with conventional measures, alternative therapies are considered. Propofol, a sedative hypnotic typically used for general anesthesia and procedural sedation, is one such medication. It has effectively been used for short-term sedation in adults and children to facilitate weaning benzodiazepines and opioids. There is a paucity of data on the use of propofol in infants for this purpose. Here we describe the use of propofol to rapidly wean high-dose sedation and analgesia medications, a propofol sedation washout, in 3 infants. The washouts proved to be safe and efficacious. Based on institutional experience and a literature review, considerations and recommendations are made for propofol sedation washouts in infants.
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