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Lookup NU author(s): Dr Peter Wright
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Background: Propofol is a commonly used anesthetic induction agent in pediatric anesthesia that, until recently, was used with caution as an intravenous infusion agent for sedation in pediatric intensive care. Few data have described propofol kinetics in critically ill children. Methods: Twenty-one critically ill ventilated children aged 1 week to 12 yr were sedated with 4-6 mg·kg-1·h-1 of 2% propofol for up to 28 h, combined with a constant morphine infusion. Whole blood concentration of propofol was measured at steady state and for 24 h after infusion using high-performance liquid chromatography. Results: A propofol infusion rate of 4 mg·kg-1·h-1 achieved adequate sedation scores in 17 of 20 patients. In 2 patients the dose was reduced because of hypotension, and 1 patient was withdrawn from the study because of a increasing metabolic acidosis. Mixed-effects population models were fitted to the blood propofol concentration data. The pharmacokinetics were best described by a three-compartment model. Weight was a significant covariate for all structural model parameters; C1, Q2, Q3, V1, and V2 were proportional to weight. Estimates for these parameters were 30.2, 16.0, and 13.3 ml·kg-1·min-1 and 0.584 and 1.36 1/kg, respectively. The volume of the remaining peripheral compartment, V3, had a constant component (103 1) plus an additional weight-related component (5.67 1/kg). Values for C1 were reduced (typically by 26%) in children who had undergone cardiac surgery. Conclusions: Propofol kinetics are altered in very small babies and in children recovering from cardiac surgery. Increased peripheral distribution volume and reduced metabolic clearance following surgery causes prolonged elimination.
Author(s): Rigby-Jones AE, Nolan JA, Priston MJ, Wright PMC, Sneyd JR, Wolf AR
Publication type: Article
Publication status: Published
Journal: Anesthesiology
Year: 2002
Volume: 97
Issue: 6
Pages: 1393-1400
ISSN (print): 0003-3022
ISSN (electronic): 1528-1175
Publisher: Lippincott Williams & Wilkins
URL: http://dx.doi.org/10.1097/00000542-200212000-00010
DOI: 10.1097/00000542-200212000-00010
PubMed id: 12459664
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