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Age-Stratified Propofol Dosage for Pediatric Procedural Sedation and Analgesia
Anesthesia & Analgesia ( IF 5.7 ) Pub Date : 2023-03-01 , DOI: 10.1213/ane.0000000000006196
Huib van Dijk 1 , Mark P Hendriks , Marga M van Eck-Smaling , Leo van Wolfswinkel , Kim van Loon
Affiliation  

Background: 

Procedural sedation and analgesia (PSA) for diagnostic and minimally invasive therapeutic procedures has become common practice in children of all ages. Based on our clinical experience, we suspected an inverse relation between age and dosage. However, a schedule for age-stratified propofol induction and maintenance dosage for PSA was not available and could be helpful to many anesthesiologists as a reference.

Methods: 

We performed a retrospective cohort study of children who received procedural sedation at the Wilhelmina Children’s Hospital (WKZ), a tertiary pediatric hospital part of the University Medical Center Utrecht (UMCU), between June 2007 and December 2020. We studied whether the induction (mg·kg−1) and maintenance (mg·kg−1·h−1) dosage is age-dependent using linear regression models.

Results: 

A total of 6438 pediatric procedures were retrieved from Anesthesia Information Management Systems (AIMS). A total of 5567 records were available for induction dose analysis and 5420 records for analysis of the maintenance dose. After adjustment for sex, American Society of Anesthesiologists (ASA) physical status classification, opioid administration, and diagnostic or interventional, we obtained a coefficient of −0.11 (95% confidence interval [CI], −0.12 to −0.11) for age (years) from a multivariable linear regression model for propofol induction dosage (mg·kg−1) and a coefficient of −0.36 (95% CI, −0.39 to −0.34) for age (years) for propofol maintenance dosage.

Conclusions: 

We found a noteworthy inverse age-effect on propofol dosage for both induction and maintenance of pediatric procedural sedation. Furthermore, our study revealed that remarkably higher propofol sedation doses were needed for infants and toddlers than previously expected and reported.



中文翻译:

用于小儿程序镇静和镇痛的年龄分层异丙酚剂量

背景: 

用于诊断和微创治疗程序的程序镇静和镇痛 (PSA) 已成为所有年龄段儿童的常见做法。根据我们的临床经验,我们怀疑年龄和剂量之间存在反比关系。然而,目前还没有按年龄分层的异丙酚诱导和 PSA 维持剂量的时间表,这可能对许多麻醉科医生有帮助作为参考。

方法: 

我们对 2007 年 6 月至 2020 年 12 月期间在威廉敏娜儿童医院 (WKZ)(隶属于乌得勒支大学医学中心 (UMCU) 的三级儿科医院)接受程序镇静的儿童进行了一项回顾性队列研究。我们研究了诱导(mg ·kg -1 ) 和维持剂量(mg·kg -1 ·h -1 ) 使用线性回归模型与年龄相关。

结果: 

从麻醉信息管理系统 (AIMS) 中检索到总共 6438 例儿科手术。总共有 5567 条记录可用于诱导剂量分析,5420 条记录可用于维持剂量分析。在对性别、美国麻醉医师协会 (ASA) 身体状况分类、阿片类药物给药以及诊断或介入进行调整后,我们获得了年龄(岁)的系数 -0.11(95% 置信区间 [CI],-0.12 至 -0.11) )来自丙泊酚诱导剂量(mg·kg -1)的多变量线性回归模型和丙泊酚维持剂量年龄(岁)的系数 -0.36(95% CI,-0.39 至 -0.34)。

结论: 

我们发现,在儿童程序镇静的诱导和维持中,丙泊酚剂量存在值得注意的逆年龄效应。此外,我们的研究表明,婴儿和幼儿所需的异丙酚镇静剂量比之前预期和报告的要高得多。

更新日期:2023-02-23
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