The safety of propofol infusion as an adjunct to regional anesthesia in children less than three years old

Background: Propofol, a sedative agent with quick onset and short duration of action, has long been used for many adult procedures requiring anesthesia and sedation. There is hesitance, however, to its use for children because of several reports of adverse events. This hesitance reflects more of a scarcity of pediatric clinical trials rather than a proven clinical problem. This study is therefore undertaken to determine the safety of propofol infusion in normal healthy children less than three years old who will undergo elective surgeries. Methods: This was a prospective study of 24 ASA I patients under 3 years of age who underwent either lower abdominal or lower extremity surgery under combined general and regional anesthesia, and cheiloplasty/palatoplasty under general anesthesia with infraorbital block. Patients were put to sleep by sevoflurane gas induction. Endotracheal intubation was facilitated by atracurium. Blood samples for arterial blood gases (ABGs), creatinine, alanine aminotransferase (ALT) and triglycerides were extracted. After the regional block was established, sevoflurane was discontinued and the propofol infusion was started. The range of vital signs, total dose of propofol and the total time it was administered were noted. After 24 hours, ABGs, creatinine, triglycerides and ALT levels were determined. Results: Pearsons Correlation test showed that no linear relationship exist between the dose of propofol and the postoperative levels of triglycerides, creatinine and ALT. Preoperative ABG analysis showed that 29 percent had metabolic acidosis, 33 percent had respiratory acidosis and 21 percent had normal values. Postoperatively, 75 percent had normal ABG results while 25 percent had metabolic acidosis. Conclusion: Propofol is safe for use in children less than 3 years of age. No significant elevations in the postoperative levels of creatinine, ALT and triglycerides were noted in the study. Majority of patients had normal ABG results postoperatively. (Author)

Intubation of a pediatric patient in prone position: an anesthetic challenge

This is a case of M.L., a five year old boy from Cavite who accidentally slipped and fell into an open canal with a protruding steel bar which pierced his back. No other injuries were sustained. The steel bar was cut shorter with a saw and the patient as brought to a local hospital with the object still impaled on his right paravertebral area. Initial physical examination findings revealed a conscious patient with a rusty steel bar impaled on T12- L1, with tenderness and bleeding on the site. Chest, lung and abdominal findings were essentially normal. Rectal examination revealed tight sphincter tone and rectal vault was not collapsed. Neurological examination showed Glasgow Coma Scale score of 15; motor function of upper extremities was 5/5, lower extremities 0/5. He was given tetanus toxoid and venocylis was started. The patient was the referred to Philippine General Hospital five hours post- injury and was subsequently admitted.