Induction Dose of Propofol for Pediatric Patients Undergoing Procedural Sedation in the Emergency Department

OBJECTIVEThis study aimed to determine if patient age is an independent predictor of the propofol dose required for the induction of sedation in pediatric patients for procedures performed in the emergency department (ED). METHODSThis is a retrospective study conducted in an academic, tertiary ED between May 2005 and October 2009. Medical records of patients younger than 18 years who received propofol for procedural sedation were evaluated. Data collected included patient demographics, procedure type, propofol doses administered, time to sedation induction, pain scores before procedure, opioid administration, and adverse effects. Factors predictive of propofol induction dose were analyzed using linear regression analyses. RESULTSEighty-eight patients were included in the final analyses. The mean age was 11 years (range, 1–17 years), and 75% were male. The mean induction dose required was 2.1 ± 1.3 mg/kg using a median of 3 boluses (interquartile range, 2–4). The mean time to induction was 3.9 ± 4.2 minutes. In the linear regression analyses (R = 0.07), patient age was inversely predictive of the induction dose (in milligram per kilogram) of propofol (coefficient = −0.074; P = 0.013). Sex, race, procedure type, pain score before procedure, and opioid administration were not predictive of induction dose. Transient respiratory depression occurred in 13.6% and hypotension occurred in 8% of patients, without further complications. CONCLUSIONSIn pediatric patients undergoing procedural sedation in the ED, age is an independent predictor of the dose of propofol required for induction of sedation. Therefore, younger patients may require higher doses by body weight (in milligram per kilogram).