Clinical study of propofol sedation via TCI in children

Objective To validate the efficacy and safety of propofol sedation via TCI during epidural anesthesia or sacral block in children and to evaluate the use of BIS as a tool for measuring the depth of sedation.Methods Twenty children scheduled for elective inguinal hernia repair(ages 4-10 yr,ASA gradesⅠ,with no neurological or psychological disorders)were enlisted in the study.Sedation was solely maintained with TCI propofol.the TCI device was programmed with Marsh adult pharmcokinetic model;other sedatives were avoided.The infusion was adjusted till an adequate sedation(OAA/S≤1) was secured before the start of sacral or epidural block.The course of propofol infusion was closely observed,with the BIS,OAA/S,Cp(predicted blood propofol concentration),vital signs etc.being monitored.Results The mean induction time(the time needed to achieve an OAA/S≤1) was(302.6±60) s,the corresponding BIS was 66±10.The recovery time after the withdrawal of propofol was(14.6±3.3) min,the BIS when patient was considered to become awake(OAA/S≥2) was 86.2±6.0.The induction dose of propofol was(1.9±0.7) mg/kg,the maintenance dose of propofol was(8.3±3.3) mg·kg-1·h-1,the predicted blood propofol concentration was 2-3 mg/L.The BIS was 62±11 during the operation.Heart rate and blood pressure were stable throughout the procedure,with no episodes of apnea encountered.The BIS was well correlated with the sedation score.Conclusion Propofol sedation via TCI programmed with Marsh adult pharmacokinetic parameters is safe and effective during pediatric surgery.BIS is an index reliable to guide the depth of sedation.