Evaluation of propofol for repeated prolonged deep sedation in children undergoing proton radiation therapy

The aim of this study is to evaluate the safety and sufficiency of a fixed dose rate propofol infusion for repeated prolonged deep sedation in children for proton radiation therapy (PRT). With ERB approval, we recorded anaesthesia monitoring data in children undergoing repeated prolonged propofol sedation for PRT. Sedation was introduced with a single bolus of i.v. midazolam 0.1 mg kg−1 followed by repeated small boluses of propofol until sufficient depth of sedation was obtained. Sedation was maintained with fixed dose rate propofol infusion of 10 mg kg−1 h−1 in all patients up to the end of the radiation procedure. Patient characteristics, number and duration of sedation, propofol induction dose, necessity to alter propofol infusion rate, and heart rate, mean arterial pressure, respiratory rate were noted at the end of the radiation procedure before cessation of the propofol infusion. Data are mean (sd) or range (median) as appropriate. Eighteen children aged from 1.4 to 4.2 yr (2.6 yr) had 27.6 (sd 2.0) (497 in total) radiation procedures within 44.1 (4.0) days lasting 55.7 (8.8) min. Propofol bolus dose for induction, monitoring, and positioning was 3.7 (1.0) mg kg−1. Propofol bolus requirements were quite stable over the successive weeks of treatment and variability was larger between individuals than over time. In none of the children did propofol infusion rate need to be changed from the pre-set 10 mg kg−1 h−1 flow rate because of haemodynamic state, respiratory conditions or inadequate anaesthesia. Repeated prolonged deep sedation over several weeks in very young children using a fixed rate propofol infusion was safe and adequate for all patients.