Jenkins Elan, Hebbar Kiran B, Karaga Katie K, Hirsh Daniel A, Fortenberry James D, McCracken Courtney E, Simoneaux Stephen F, Mallory Michael D, Kamat Pradip P
Department of Pediatrics, Emory University School of Medicine, 1405 Clifton Road NE, Atlanta, GA, 30322, USA.
Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA.
Pediatr Radiol. 2017 Jul;47(8):974-983. doi: 10.1007/s00247-017-3844-7. Epub 2017 May 9.
There is an increased risk associated with procedural sedation of infants younger than 6 months of age. The use of propofol for radiologic imaging of this age group is not well studied.
We hypothesize that adverse events are higher in the infant population receiving propofol for radiologic imaging.
A retrospective chart review was undertaken of 304 infants younger than 6 months old who received propofol for procedural sedation from October 2012 to February 2015. Patient demographics, propofol dosing, sedation-related adverse events and interventions were collected. Serious adverse events were defined as laryngospasm, aspiration, the need for admission, cardiac arrest or death.
Procedural sedation for radiologic imaging was successful in 301/304 (99%) of infants using propofol. Of these 304 patients, 130 (42.8%) patients were female, and 240 of the 304 (79%) were between 3 and 6 months of age. The majority of patients (172/304 [56.6%]) were American Society of Anesthesiologists-Physical Status Class II. There were 57 sedation-related, minor adverse events in 39 out of 304 (12.8%) patients. Thirteen of the 304 (4.3%) patients had 14 serious adverse events, with airway obstruction the most common. Eighty interventions were required in 56/304 (18.4%) patients. The most common interventions were continuous positive airway pressure (CPAP) in 25/304 patients (8.2%) and jaw thrust in 15/304 (4.9%). The median induction propofol dose was 4.7 mg/kg. A need for an increase in the propofol infusion rate during the procedure was noted in 162/304 (53.3%) infants. No significant predictors of sedation-related adverse events were detected.
Propofol can be used for radiologic imaging of infants younger than 6 months of age with a high success rate. Practitioners should be mindful of significantly higher dosing requirements and a higher incidence of airway events, which can be easily identified and managed by a team of experienced sedation providers.
6个月以下婴儿在进行程序性镇静时风险增加。丙泊酚用于该年龄组的放射影像学检查尚未得到充分研究。
我们假设接受丙泊酚进行放射影像学检查的婴儿人群中不良事件发生率更高。
对2012年10月至2015年2月期间接受丙泊酚进行程序性镇静的304名6个月以下婴儿进行回顾性病历审查。收集患者人口统计学资料、丙泊酚剂量、与镇静相关的不良事件及干预措施。严重不良事件定义为喉痉挛、误吸、需要住院、心脏骤停或死亡。
304名使用丙泊酚进行放射影像学检查的婴儿中，301例（99%）程序性镇静成功。在这304例患者中，130例（42.8%）为女性，304例中的240例（79%）年龄在3至6个月之间。大多数患者（172/304 [56.6%]）为美国麻醉医师协会身体状况分级II级。304例患者中有39例（12.8%）发生了57次与镇静相关的轻微不良事件。304例患者中有13例（4.3%）发生了14次严重不良事件，气道梗阻最为常见。56/304（18.4%）例患者需要80次干预措施。最常见的干预措施是25/304例患者（8.2%）采用持续气道正压通气（CPAP），15/304例患者（4.9%）采用下颌前推。丙泊酚诱导剂量的中位数为4.7mg/kg。162/304（53.3%）例婴儿在检查过程中需要增加丙泊酚输注速率。未发现与镇静相关不良事件的显著预测因素。
丙泊酚可用于6个月以下婴儿的放射影像学检查，成功率较高。从业者应注意更高的剂量需求和更高的气道事件发生率，经验丰富的镇静团队可轻松识别并处理这些情况。
