Clinical Professor Dept Anesthesiology SUNY @ Buffalo
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Introduction: Propofol is commonly used for pediatric deep sedation, but its pharmacokinetics vary by age and weight, making standard dosing unpredictable. Total intravenous anesthesia (TIVA) typically targets plasma levels, but this may lead to over- or under-sedation in children. We developed a kinetic-based propofol dosing algorithm incorporating Paedfusor and Diprifusor models, using clinical endpoints rather than fixed plasma levels. We hypothesized this method would maintain consistent sedation depth, measured by BIS (Bispectral Index), across different age groups despite dosing variability.
Methods: After IRB approval and consent, patients aged 5–21 were grouped by age: A (5–7), B (8–12), C (13–17), and D (18–21). All underwent dental or oral surgery procedures under deep sedation (RASS -4) using midazolam, fentanyl, and the kinetic-based propofol infusion. BIS electrodes were applied after loss of consciousness (Groups A/B) or before sedation (Groups C/D), and BIS data were recorded in real time. Propofol infusion rates were age-based (155–370 mcg/kg/min) and adjusted based on jaw thrust response. All sedation agents were weight-adjusted using a custom formula. Continuous monitoring included EKG, NIBP, pulse oximetry, and ETCO₂. BIS data were analyzed for stability and depth of sedation.
Results: Forty-eight patients were enrolled; BIS data were unavailable in two cases from Group C. The average age was 12 years. Younger patients had lower BMI and required longer induction, recovery, and higher doses of all three agents. Mean doses were midazolam 0.01 mg/kg, fentanyl 1.74 mcg/kg, and propofol 4.1 mg/kg. Propofol dosing and modeled plasma levels were higher in younger groups. Despite this, BIS values remained stable across all groups, with no significant difference in mean BIS scores (range: high 50s to low 60s), indicating consistent sedation depth.
Conclusions: The kinetic-based propofol dosing algorithm achieved stable, deep sedation across all pediatric age groups. BIS monitoring confirmed consistent sedation depth despite dose variability. The slow induction protocol minimized airway risk and supported safe, office-based deep sedation in children and young adults.
