[Practical methods of using propofol as a complement to loco-regional anesthesia in children]

Propofol fulfills most of the requirements for the ideal intravenous agent usable in conjunction with regional anesthesia in children, especially for outpatient surgery. Some limitations are easily overcome by simple means such as contact anesthesia of the skin prior to venous puncture or addition of lidocaine (1 ml 1% lidocaine in 20 ml of propofol). In clinical practice, it is mandatory that the sites of puncture (venous line as well as block technique) be anesthetized by skin application of EMLA cream and that anxious children be given premedication (0.3 mg.kg-1 of rectal midazolam). Recommended induction dose of propofol is 3 to 4 mg.kg-1. Maintenance of anesthesia can be achieved either by continuous infusion of 2 to 5 mg.kg-1.h-1 of propofol or by inhalation anesthesia with low concentrations of halogenated agents. Spontaneous ventilation through a face mask or a laryngeal mask is usually made possible. Satisfactory conditions for performing the regional block technique are especially obtained when the skin at the site of puncture is anesthetized. Adverse effects are unusual and mainly consist of undesirable movements, the occurrence of which is favored by the existence of a differential sensory block. Propofol allows easy and complete post-anesthesia awakening and it has anti emetic and anxiolytic effects: due to these properties, it is remarkably suitable for use in association with regional anesthesia in children.