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Changes in respiratory and hemodynamic parameters during low‐dose propofol sedation in combination with regional anesthesia for herniorrhaphy and genitourinary surgery in children
Author(s) -
ZANABONI SILVIO,
KRAUSS BARUCH,
BUSCAGLIA RAFFAELLA,
MONTAGNINI CLAUDIA,
GRATAROLA ANGELO,
GUALINO JENNY,
COLOMBO ROBERTO,
CORTE FRANCESCO DELLA
Publication year - 2007
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2007.02299.x
Subject(s) - medicine , propofol , anesthesia , sedation , hemodynamics , ventilation (architecture) , mechanical ventilation , surgery , mean arterial pressure , blood pressure , heart rate , mechanical engineering , engineering
Summary Background: Spontaneous vs mechanical ventilation during propofol sedation has been a subject of debate. We evaluated the safety of low‐dose propofol sedation as an adjunct to regional anesthesia during herniorrhaphy and genitourinary surgery in infants and children. Methods: The study was conducted in a prospective, nonrandomized manner using a consecutive sample of 62 American Society of Anesthesiologists physical status class I patients between 5 months to 11 years of age in the surgery unit of an urban University Hospital. Propofol sedation (4–8 mg·kg −1 ·h −1 continuous infusion) was used with regional anesthesia (caudal, ilioinguinal/iliohypogastric nerve or penile block with 0.2–0.375% ropivacaine). All children were spontaneously breathing without an anesthesia circuit. Respiratory and hemodynamic parameters were continuously recorded on all patients. One‐way analysis of variance ( anova ) for repeated measurements was used to analyze changes in respiratory and hemodynamic parameters during the procedure. Results: Spontaneous ventilation was maintained in all patients with minimal changes in hemodynamic parameters. Heart rate, mean arterial pressure, and P E CO 2 remained stable throughout the study period: 23/62 (37%) patients exhibited signs of developing intrinsic endexpiratory pressure (PEEPi) or the presence of PEEPi because of progressive reduction of expiratory time. Conclusions: Low‐dose propofol sedation in combination with regional anesthesia for elective herniorrhaphy and genitourinary surgery in children maintains spontaneous ventilation and has minimal effects on hemodynamic parameters for sedation lasting <1 h. The presence of PEEPi is a relative contraindication to the use of this regimen in children with asthma or history of upper airway infections.