• Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SPS Newsletter

An official publication of the Society for Pediatric Sedation

An official publication of the
Society for Pediatric Sedation®

    • Leadership Messages
      • Recognizing Excellence and Reinvesting in our Membership 
    • Literature Reviews
      • Pediatric Procedural Sedation Using the Combination of Ketamine and Propofol Outside of the Emergency Department 
      • Optimal Volume of Administration of Intranasal Midazolam in Children: A Randomized Clinical Trial 
      • Current State of Institutional Privileging Profiles for Pediatric Procedural Sedation Providers 
      • Association of BMI With Propofol Dosing and Adverse Events in Children With Cancer Undergoing Procedural Sedation 
    • Quality & Safety
      • Building a Sedation Quality Dashboard 
      • Review of the Pediatric Sedation State Scale 
    • Cautionary Tales
      • Sedation for Children Undergoing Multiple Procedures 
    • Membership
      • SPS Membership and Communications Committee Fall Newsletter Update 
    • Research
      • SPS Research Committee Update

Association of BMI With Propofol Dosing and Adverse Events in Children With Cancer Undergoing Procedural Sedation
Reviewed by Lorie Reilly, MSN, CRNP, CPNP-AC
The Children’s Hospital of Philadelphia

Rogerson C, Abulebda K, Hobson M Hospital Pediatrics. 2017 Sept 7(9): 542-546.

Abstract
Objectives:
This study examined the effect of BMI, from underweight to obesity, on dosing of propofol and adverse events for children with cancer who were deeply sedated for painful procedures.

Methods
Retrospectively they studied pediatric oncology patients over a five-year span (2010-2015). The patients received an initial dose of ketamine prior to propofol boluses (1-2mg/kg at start of sedation and 0.5-1mg/kg for subsequent doses as needed). Procedures included lumbar punctures, bone marrow aspirates or both. They calculated BMI and monitored adverse events (hypoxemia, apnea, bradycardia and hypotension).

Results
The 1,976 cases in the study were not significantly different in terms of age with consideration of weight and procedure. Overweight (BMI > 85th percentile) and obese (BMI > 95th percentile) children achieved deep sedation with significantly lower doses of propofol per kg of body weight as compared to those children of normal body weight. Underweight children required similar propofol dosing as normal weight children.  Underweight children experienced more adverse events than normal weight children, yet there was no significant difference between the number of adverse events among the four weight categories of the patients (underweight, normal weight, overweight and obese).

Conclusions
Children can still be successfully sedated at lower doses of propofol to minimize adverse events.  Underweight children may be at risk for complications during sedation.

Commentary
We have all seen firsthand the rise in obesity in the children we sedate yet we may not often consider the risk of complications with the underweight population. The authors of the above study remind us of the impact of BMI across the spectrum. They confirmed the impact of underweight and its impact on sedation (respiratory muscle weakness from malnourishment, less adipose tissue for propofol to circulate). Although the authors did acknowledge that the propofol dosing was decided by the individual physicians, perhaps we need to consider smaller dosing with the underweight population.

On a larger scale, Scherrer et al similarly explored adverse events and interventions with the obese population in a larger retrospective analysis provided by data from the Pediatric Sedation Research Consortium. This manuscript entitled: The impact of obesity on pediatric procedural sedation-related outcomes: Results from the Pediatric Sedation Research Consortium was published in Pediatric Anesthesia in 2014 (Volume 25, pages 689-697). Of the 28,792 records analyzed, they noted that 17.9% of these patients were obese and experienced more adverse events (airway obstruction, oxygen desaturation, secretions requiring treatment and laryngospasm). They also found that a higher percentage of these obese patients had an inability to complete procedures and prolonged recovery.

Both of these studies remind us of the importance of BMI as we prescreen and sedate our patients. Further studies are warranted, especially regarding the dosing of sedation medications and consideration of total body weight versus ideal body weight. Although the sedation providers should be prepared to manage adverse events, our goal is to minimize their occurrence and administer the minimal amount of medication to achieve the desired level of sedation in the safest of circumstances.

Primary Sidebar

NEXT MEETING

View the program and register through the Mobile Meeting Guide.

CME MODULES

Check out the Society’s online educational modules for physicians and nurses.

 

Footer

About SPS News

SPS News is an official publication of the Society for Pediatric Sedation®

SPS News Editor
Carmen D. Sulton, MD

Contributing Authors
Nancy Crego, PhD, RN, CCRN
Benjamin F. Jackson, MD
Sue Kost, MD
Ali Ozcan, MD
Amber Rogers, MD
Anne Stormorken, MD

Share Your News!

Have an interesting story about your sedation team to share? Has your institution recently been recognized for something? We are looking for content for the next issue of SPS News, due out this summer.

Being a contributor is a great way to get involved in the Society. Contact Joye Stewart at the SPS headquarters office.

Get your SPS member app!

Take full advantage of your membership and download the SPS Member App for quick access to:

  • Renew your dues
  • Conference information
  • SPS News
  • Member section
  • And more!
It's available at your app store!

Copyright © 2021 Society for Pediatric Sedation