Klein Scott M, Hauser Gabriel J, Anderson Barry D, Shad Aziza T, Gootenberg Joseph E, Dalton Heidi J, Hertzog James H
Division of Pediatric Critical Care and Pulmonary Medicine, Department of Pediatrics, Georgetown University Medical Center, Washington, DC 20007, USA.
Pediatr Crit Care Med. 2003 Jan;4(1):78-82. doi: 10.1097/00130478-200301000-00016.
To compare the effects of administering propofol as a continuous infusion vs. bolus dosing in children undergoing ambulatory oncologic procedures in the pediatric intensive care unit (PICU).
Prospective, randomized study.
Tertiary PICU in a university hospital.
Ambulatory oncology patients scheduled for diagnostic or therapeutic procedures with propofol anesthesia in the PICU were eligible for enrollment.
Patients were randomly assigned to receive either continuous infusion or bolus administration of propofol in a protocol-driven manner. All patients received an initial bolus of 1.5 mg/kg, with additional 0.5 mg/kg doses until complete induction. Continuous infusions were started at 0.1 mg/kg/min and, if needed, increased 20% after a bolus of 0.5 mg/kg. Bolus group patients were given doses of 0.5 mg/kg if needed. Ramsay scores of < 5 were used as criteria for additional dosing.
Eighteen patients undergoing 40 separate procedures were enrolled during the study period. Twenty procedures each were performed with continuous or bolus administration of propofol. No differences were present between groups in demographic characteristics, induction dose and time, procedure and recovery times, or adverse events. All patients had adequate anesthesia and favorable satisfaction scores. More boluses were needed in the bolus group (8.5 +/- 4.6 vs. 5.4 +/- 2.9; p < .05). Average systolic blood pressure decreased more in the continuous infusion group (26.4% +/- 12 vs. 19.3% +/- 10; p < .05). Total propofol dose was higher in the continuous infusion group (8.0 mg/kg +/- 3.8 vs. 5.7 mg/kg +/- 2.4; p < .05).
Both continuous and bolus administration of propofol provided conditions for conducting oncologic procedures that were satisfying to patients, their families, and physicians. Continuous infusions were associated with a larger total dose and greater decreases in systolic blood pressure. Physician preference is likely to dictate which method is used.
比较在儿科重症监护病房（PICU）接受门诊肿瘤手术的儿童中，丙泊酚持续输注与大剂量给药的效果。
前瞻性随机研究。
大学医院的三级PICU。
计划在PICU接受丙泊酚麻醉进行诊断或治疗手术的门诊肿瘤患者符合入组条件。
患者按照方案驱动的方式随机分配接受丙泊酚持续输注或大剂量给药。所有患者均先给予1.5mg/kg的初始负荷剂量，随后根据需要追加0.5mg/kg剂量直至完全诱导。持续输注从0.1mg/kg/min开始，如有需要，在追加0.5mg/kg负荷剂量后增加20%。大剂量组患者根据需要给予0.5mg/kg剂量。Ramsay评分<5作为追加给药的标准。
研究期间共纳入18例患者，进行了40次独立手术。丙泊酚持续输注和大剂量给药各进行了20次手术。两组在人口统计学特征、诱导剂量和时间、手术及恢复时间或不良事件方面均无差异。所有患者麻醉效果良好，满意度评分较高。大剂量组需要更多的推注次数（8.5±4.6 vs. 5.4±2.9；p<0.05）。持续输注组平均收缩压下降幅度更大（26.4%±12 vs. 19.3%±10；p<0.05）。持续输注组丙泊酚总剂量更高（8.0mg/kg±3.8 vs. 5.7mg/kg±2.4；p<0.05）。
丙泊酚持续输注和大剂量给药均为进行肿瘤手术提供了令患者、其家属和医生满意的条件。持续输注与更高的总剂量和更大幅度的收缩压下降相关。医生的偏好可能决定使用哪种方法。
