Assessment of Swallowing Function in Patients with Head and Neck Squamous Cell Carcinoma in High vs. Low Dose Cisplatin.

Cisplatin-based therapies are standard-of-care for advanced-stage head and neck squamous cell carcinoma (HNSCC). Treatment regimens include 3 weeks of high-dose bolus cisplatin or 6-7 weeks of low-dose weekly cisplatin, both with concurrent radiation. The effects of cisplatin dosage on swallowing function warrant further study. A 237-patient cohort treated for HNSCC at a single center were studied retrospectively. Gastrostomy tube dependence served as the primary endpoint. Secondary endpoints included weight changes, esophageal stricture, and lymphedema. The primary/secondary outcomes were not statistically significant; however, ototoxicity and renal toxicity were significantly higher in the high-dose group. These findings add insight into cisplatin dose-based functional outcomes.

Propofol Use in Pediatric Sedations: Will a Lesser Dose be Effective? A Quality Improvement Project.

BACKGROUND: Propofol provides sedation in the pediatric setting for imaging interventions, ensuring minimal movement from patients and high-quality pictures. Sanford Children's outpatient sedation clinic currently does not have a standard protocol for using propofol for sedation. METHODS: The study had three phases. The first phase was a 6-month retrospective chart review of propofol drip dose. The second phase introduced a goal propofol drip dose of 200-300 mcg/kg/min with reviewing success of sedation for 6 months. Lastly, the third phase introduced a goal propofol drip dose of 175-200 mcg/kg/min with reviewing success of sedation for 6 months. A successful sedation was determined by completing the imaging study without the child awakening. RESULTS: The study was conducted at a pediatric outpatient center. A total of 181 patients ranging in ages 6 months to 16 years were recruited. Percentage of successful sedations in Phase 2 and Phase 3 were 83% and 84%, respectively. The average total propofol dose decreased from 15.43 mg/kg in the first part of the study to 12.31 mg/kg in the last phase. Lastly in the final phase, 44% of patients had a mean arterial pressure (MAP) below the normal range. CONCLUSION: When evaluating the dose of propofol as a sedative for imaging intervention at Sanford Children's, a lower dose of propofol was 84% successful compared to a higher dose. Overall, we concluded that it is appropriate to create a sedation protocol with a target dose of 175-200 mcg/kg/min.

Propofol Use in Pediatric Sedations: Will a Lesser Dose be Effective? A Quality Improvement Project.

BACKGROUND: Propofol provides sedation in the pediatric setting for MRIs, ensuring minimal movement from patients and high-quality pictures. Sanford Children's outpatient sedation clinic currently does not have a standard protocol for using propofol for sedation. The purpose of the project was to determine if we could decrease the dose of propofol while maintaining adequate sedation during MRI imaging. METHODS: The study had three phases of retrospective chart review. The first phase was a six-month review of propofol dosing. The second phase introduced a goal propofol drip dose of 200-300 mcg/kg/min with reviewing success of sedation for six months. Lastly, the third phase introduced a goal propofol drip dose of 175-200 mcg/kg/min with reviewing success of sedation for four months. A successful sedation was determined by completing the imaging study without the child awakening. RESULTS: A total of 181 patients ranging in ages 6 months to 16 years were recruited. Percentage of successful sedations in phase 2 and phase 3 were 83 percent and 84 percent, respectively. The average total propofol dose used in sedations decreased from 15.43 mg/kg in phase 1 to 12.31 mg/kg in phase 3. On average of the three phases, the mean arterial pressure (MAP) overall was below the normal range in 60 percent of sedations. CONCLUSION: We conclude that creating a protocol with a baseline propofol drip rate of 175-199 mcg/kg/min for pediatric sedations would allow for successful sedations and prevent unnecessary excess dosing.