Propofol for Anesthesia in Pediatric Patients With Epilepsy on the Ketogenic Diet: A Single-Center Experience
Paul H Bui1, Maureen Handoko2, Gloria Diaz-Medina2
1Department of Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
Insights
Propofol bolus and short infusions for anesthesia in patients on a ketogenic diet (KD) did not lead to propofol infusion syndrome (PIS). This study found no PIS cases in 65 patients undergoing 165 anesthetic encounters.
Area of Science:
- Anesthesiology
- Clinical Pharmacology
- Pediatric Anesthesia
Background:
- Ketogenic diet (KD) use is associated with contraindications for propofol due to increased risk of propofol infusion syndrome (PIS).
- Limited data exists on the safety of propofol in patients adhering to a KD.
Purpose of the Study:
- To describe the anesthetic experience with propofol bolus and short infusions in patients on a KD.
- To evaluate for any signs of PIS in this patient cohort.
Main Methods:
- Retrospective review of 65 patients (1-20 years) on KD who received propofol anesthesia between 2012-2022.
- Analysis of 165 anesthetic encounters (123 boluses, 42 infusions) for surgical procedures.
- Assessment for PIS signs: cardiac arrhythmias, acidosis, rhabdomyolysis, hypoglycemia, unplanned admissions, aborted procedures, and increased seizure frequency.
Main Results:
- No cases of propofol infusion syndrome (PIS) were identified in any of the 165 anesthetic encounters.
- Four encounters developed acidosis, one rhabdomyolysis, and one increased seizures; none were attributed to propofol.
- Adverse events were infrequent and not linked to propofol administration in patients on a KD.
Conclusions:
- Propofol boluses and brief infusions are safe for anesthetic use in patients on a ketogenic diet (KD).
- The study cohort did not exhibit any signs or symptoms indicative of propofol infusion syndrome (PIS).
Background:
Propofol use is contraindicated in patients on ketogenic diet (KD) due to higher risk of propofol infusion syndrome (PIS). This study is intended to provide a descriptive analysis of our experience with propofol bolus and short infusions for anesthetic care in patients on the KD and to evaluate if any signs of PIS were observed.
Methods:
All patients on the KD who underwent anesthesia with propofol between 2012 and 2022 were reviewed. Anesthetic encounters and charts were studied for type of surgical procedure; signs of PIS, including new cardiac arrhythmias, acidosis, or rhabdomyolysis in the periprocedural period; hypoglycemia; unplanned admissions within 24 hours of the procedure; if procedure was unexpectedly aborted; and increased seizure frequency within one week.
Results:
We identified 65 patients, aged from one to 20 years who underwent 165 anesthetic encounters with propofol, of which 123 were boluses and 42 were infusions. In bolus dosing, the average dose was 2.8 mg/kg (0.7 to 12.8 ± 1.8 mg/kg). Of these, four encounters developed acidosis, one developed rhabdomyolysis, and one developed increased seizures. With infusions, the average infusion rate was 9 mg/kg/hour, with mean infusion duration of 83 minutes (10 to 352 ± 75 minutes). Of these, one developed acidosis and one increased seizures. No cases of PIS were identified. None of the adverse effects were attributed to propofol.
Conclusions:
Boluses and brief infusions of propofol for anesthetic use in patients on the KD did not cause PIS in our cohort.
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