Do We Need a Fluid Bolus? The Necessary Refinement of Pediatric Propofol Sedation - a Quality Improvement Project

Propofol is commonly used for pediatric MRIs to minimize patient movement. At our institution, intensivists typically administer a prophylactic 20 ml/kg saline bolus to maintain blood pressure (BP) during propofol sedation. This quality improvement project assessed whether a 10 ml/kg and a completely eliminated saline bolus are as effective as the standard 20 ml/kg bolus in completing pediatric propofol sedation and maintaining Mean Arterial Pressure (MAP).

We reviewed pediatric propofol sedations over an 18 month period in which pediatric intensivists administered the standard 20 ml/kg saline bolus, a reduced 10 ml/kg bolus, and no saline bolus. Successful sedation meant completing the MRI without complications.

172 patients aged 19 months to 16 years were assessed. The percentage of successful sedations with a 20 ml/kg bolus, 10 ml/kg bolus, and no saline bolus was 92%, 100%, and 91%, respectively. There was a statistically significant higher average MAP in the 0 ml/kg group than in the 10 and 20 ml/kg cohorts (p = 0.002). No patients required an additional bolus to maintain blood pressure.

The preservation of hemodynamic stability without a saline bolus supports the literature that the saline bolus can be safely reduced during pediatric propofol sedation for MRI.