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Safety and efficacy of sedation with propofol for transoesophageal echocardiography in children in an outpatient setting

Published online by Cambridge University Press:  22 March 2006

Christopher R. Mart ,
Mitchell Parrish ,
Kerry L. Rosen ,
Michael D. Dettorre ,
Gary D. Ceneviva ,
Steven E. Lucking  and
Neal J. Thomas
Christopher R. Mart
Affiliation:
Paediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America
Mitchell Parrish
Affiliation:
School of Medicine, Pennsylvania State University, Hershey, Pennsylvania, United States of America
Kerry L. Rosen
Affiliation:
Paediatric Critical Care, Pennsylvania State University, Hershey, Pennsylvania, United States of America
Michael D. Dettorre
Affiliation:
Paediatric Critical Care, Pennsylvania State University, Hershey, Pennsylvania, United States of America
Gary D. Ceneviva
Affiliation:
Paediatric Critical Care, Pennsylvania State University, Hershey, Pennsylvania, United States of America
Steven E. Lucking
Affiliation:
Paediatric Critical Care, Pennsylvania State University, Hershey, Pennsylvania, United States of America
Neal J. Thomas
Affiliation:
Paediatric Critical Care, Pennsylvania State University, Hershey, Pennsylvania, United States of America
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Abstract

Background: Transoesophageal echocardiography has become a powerful tool in the diagnosis and management of children with congenital cardiac malformations. Unlike adults, children will not tolerate transoesophageal echocardiography under light sedation. This study was undertaken, therefore, to evaluate the safety and efficacy of deep sedation with propofol for transoesophageal echocardiography in children examined in an outpatient setting. Methods: This is a retrospective study of patients undergoing transoesophageal echocardiography with propofol given in bolus aliquots to achieve a level of sedation adequate to insert the transoesophageal echocardiographic probe and maintain sedation throughout the procedure. Results: We included a total of 118 patients, 57% being male, with a mean age of 12.9 years. Adequate sedation was achieved using a mean propofol dose of 8.3 milligrams per kilogram, with the dose per kilogram decreasing concomitant with increasing weight of the patient. Patients less than two years of age were intubated for the procedure. There were no clinically significant changes in cardiac function or haemodynamics. Non-intubated patients received supplemental oxygen prior to, or just after, the onset of sedation, with transient hypoxaemia observed in one-fifth. Complications were rare, with minor problems occurring in 7.6%, and major ones in 4%. Conclusions: Transoesophageal echocardiography can be performed on an outpatient basis in children with a wide spectrum of congenital cardiac malformations, and propofol is an ideal sedative agent in this setting. Although not common, preparations must be made for significant haemodynamic and respiratory complications. In our study, we intubated all the children under 2 years of age.

Keywords

Paediatric cardiologyanaesthesia, aliquot
Type
Original Article
Information
Cardiology in the Young , Volume 16 , Issue 2 , April 2006 , pp. 152 - 156
Copyright
© 2006 Cambridge University Press

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