ABSTRACT
OBJECTIVES: This study aimed to determine if short-duration procedural sedation in children with propofol is related to an adverse metabolic stress response measured by serum lactate. Propofol infusion syndrome is associated with high-dose and long-duration infusion. It has not been studied with short-duration, outpatient propofol administration. METHODS: This was a prospective, longitudinal study that included 50 patients between the ages of 2 and 18 years who were undergoing outpatient procedural sedation with propofol at a pediatric sedation unit. Patients received bolus or bolus and continuous infusion doses of propofol. Serum lactate values were obtained before and after the patients' sedated procedures. RESULTS: The average length of procedure was 40.3 minutes, and the mean dose of propofol per patient was 8.2 mg/kg. The highest measured lactate value was 1.8 mmol/L. The average (SD) preprocedure and postprocedure lactate values were 1.0 (0.3) and 0.7 (0.2) mmol/L, respectively, resulting in an overall significant decrease in lactate of -0.3 (0.3) mmol/L (P < 0.001). There was a significant (P = 0.01) positive relationship between age and postprocedure lactate value, when controlling for the length of the procedure in a multivariable regression. No significant association was found between propofol dosage and length of the procedure with lactate values. CONCLUSION: In this study, we did not find a significant increase in metabolic stress, measured by serum lactate. Using propofol for short-duration procedural sedation may not carry similar risks for propofol infusion syndrome to those for long-duration/high-dose infusion therapy.
Subject(s)
Hypnotics and Sedatives/adverse effects , Lactates/blood , Propofol/adverse effects , Adolescent , Child , Child, Preschool , Critical Care , Dose-Response Relationship, Drug , Humans , Hypnotics and Sedatives/administration & dosage , Longitudinal Studies , Propofol/administration & dosage , Prospective Studies , Time FactorsABSTRACT
Point-of-care ultrasound is an expanding diagnostic tool in the pediatric emergency department. We describe a case of testicular rupture diagnosed by ultrasound at the bedside, which led to prompt surgical intervention and repair.
Subject(s)
Point-of-Care Systems , Testis/injuries , Ultrasonography/methods , Adolescent , Humans , Male , Rupture , Testis/diagnostic imagingSubject(s)
Fever/etiology , Genital Diseases, Female/complications , Genital Diseases, Female/diagnosis , Pain/etiology , Ulcer/complications , Ulcer/diagnosis , Anesthetics, Local/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Child , Clobetasol/therapeutic use , Diagnosis, Differential , Female , Fever/drug therapy , Fever/physiopathology , Genital Diseases, Female/drug therapy , Genitalia, Female/physiopathology , Humans , Lidocaine , Pain/drug therapy , Pain/physiopathology , Ulcer/drug therapyABSTRACT
"Limp" is a common complaint of children presenting to the emergency department or physician's office. For most patients presenting with limp, the diagnosis and management can be completed in the physician's office or emergency department by gathering a detailed history, performing a careful physical examination, and requesting a few laboratory and imaging studies. This article reviews common causes of atraumatic limp in children and discusses the evaluation and management of these conditions.
