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Comparison of different propofol target-controlled infusion concentrations in children with autism spectrum disorder
1Department of Anesthesiology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, 136 Zhongshan Second Road, Yuzhong District, Chongqing, China.
Insights
A lower propofol concentration (2.0 µg/mL) is safe and effective for sedating children with autism spectrum disorder (ASD) during functional MRI (fMRI). This concentration offers a more stable hemodynamic profile and faster recovery compared to higher concentrations.
Area of Science:
- Pediatric Anesthesiology
- Neuroimaging
- Autism Spectrum Disorder Research
Background:
- Sedation is crucial for functional magnetic resonance imaging (fMRI) in children with autism spectrum disorder (ASD).
- Target-controlled infusion (TCI) propofol offers precise sedation control.
- Optimizing propofol concentration is key for balancing efficacy and safety in this population.
Purpose of the Study:
- To compare the safety and efficacy of two TCI propofol concentrations (2.0 µg/mL vs. 2.5 µg/mL) for sedation during cranial fMRI in children with ASD.
- To determine the optimal propofol concentration for achieving successful sedation with minimal adverse events.
Main Methods:
- A randomized controlled trial involving 120 preschool children with ASD undergoing fMRI.
- Two groups received either 2.0 µg/mL or 2.5 µg/mL propofol TCI.
- Outcomes included sedation success rates, vital signs, adverse events, drug dosage, and recovery times.
Main Results:
- High and comparable first-time sedation success rates in both groups (91.67% vs. 96.67%).
- The 2.0 µg/mL group showed a more stable hemodynamic profile with less reduction in systolic blood pressure.
- The 2.0 µg/mL group required lower maintenance doses, had shorter recovery times, and smoother emergence.
Conclusions:
- A propofol TCI concentration of 2.0 µg/mL is effective and safe for fMRI sedation in children with ASD.
- The 2.0 µg/mL concentration is clinically preferable due to improved hemodynamic stability, reduced drug requirements, and faster, smoother recovery.
- This finding supports the use of lower propofol concentrations for optimizing sedation in pediatric neuroimaging.
Abstract:
This study aimed to compare the safety and efficacy of two target-controlled infusion (TCI) concentrations of propofol for sedation during cranial functional magnetic resonance imaging (fMRI) in children with autism spectrum disorder (ASD). A total of 120 preschool children with ASD scheduled for fMRI between January 2021 and July 2023 were enrolled and randomized into two groups: a low-concentration group (2.0 µg/mL, n = 60) and a high-concentration group (2.5 µg/mL, n = 60). Vital signs, sedation parameters, and adverse events were meticulously recorded to assess outcomes. The first-time sedation success rate was high and comparable between the 2.0 group and the 2.5 group (91.67% vs. 96.67%, p = 0.439). However, the 2.5 group demonstrated a significant reduction in mean systolic blood pressure (p = 0.001). While the overall incidence of adverse events was not significantly different, respiratory and circulatory depression events were less frequent in the 2.0 group. Furthermore, the 2.0 group required a significantly lower maintenance dose of propofol (p < 0.001), experienced a shorter recovery time (p = 0.042), and had a smoother emergence profile. In conclusion, a propofol TCI concentration of 2.0 µg/mL is effective and safe for fMRI sedation in children with ASD and is clinically preferable to 2.5 µg/mL due to a more stable hemodynamic profile, reduced drug requirement, and faster, smoother recovery.Trial registration: ChiCTR2100050071.
