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Understanding time to peak effect of propofol as sole agent on bispectral index in children aged 2-12 years

Gil Gavel1,2, Gilbert Koch3, Axel Terrier4

  • 1St. Anna Kinderspital, Wien, Austria.

Paediatric Anaesthesia
|July 31, 2024
PubMed

Insights

Propofol

Area of Science:

  • Pharmacology
  • Pediatric Anesthesia
  • Pharmacokinetics

Background:

  • Previous propofol pharmacodynamic studies in children were potentially confounded by co-administered drugs.
  • Age-dependent differences in propofol onset have been suggested but not definitively established.
  • This study aimed to isolate the effects of age and weight on propofol's hypnotic onset.

Purpose of the Study:

  • To characterize the influence of age and weight on the onset of propofol's hypnotic effects in children.
  • To determine the time to peak propofol effect-site concentration without confounding medications.
  • To compare propofol's onset in younger (2-6 years) versus older (8-12 years) children.

Main Methods:

  • Prospective observational cohort study of 46 healthy children (2-12 years).
  • Propofol administered via target-controlled infusion using the Paedfusor model.
  • Bispectral Index (BIS) and infusion pump data recorded; nonlinear mixed-effects modeling used.

Main Results:

  • Time to peak propofol effect-site concentration was significantly influenced by age and weight (p < .01).
  • Older children (8-12 years) had a longer time to peak effect (99 secs) compared to younger children (2-6 years) (84 secs).
  • Weight also affected time to peak effect, with heavier children (30-63 kg) showing longer onset times (99 secs) than lighter children (11-25 kg) (82 secs).

Conclusions:

  • Both age and weight significantly influence the time to peak propofol effect in children.
  • In the absence of opioids and benzodiazepines, propofol's onset is approximately 20% longer in older children (8-12 years) compared to younger children.
  • These findings highlight the importance of individualized propofol dosing titration based on age and weight.
Abstract

Keywords:
EEGanesthesiabispectral indexmathematical modelpeak effectpediatricspharmacodynamicspharmacometricspropofol

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