Cardiology in the Young



Original Article

Safety and efficacy of sedation with propofol for transoesophageal echocardiography in children in an outpatient setting


Christopher R. Mart a1c1, Mitchell Parrish a2, Kerry L. Rosen a3, Michael D. Dettorre a3, Gary D. Ceneviva a3, Steven E. Lucking a3 and Neal J. Thomas a3
a1 Paediatric Cardiology, University of Utah, Salt Lake City, Utah, United States of America
a2 School of Medicine, Pennsylvania State University, Hershey, Pennsylvania, United States of America
a3 Paediatric Critical Care, Pennsylvania State University, Hershey, Pennsylvania, United States of America

Article author query
mart cr   [PubMed][Google Scholar] 
parrish m   [PubMed][Google Scholar] 
rosen kl   [PubMed][Google Scholar] 
dettorre md   [PubMed][Google Scholar] 
ceneviva gd   [PubMed][Google Scholar] 
lucking se   [PubMed][Google Scholar] 
thomas nj   [PubMed][Google Scholar] 

Abstract

Background: Transoesophageal echocardiography has become a powerful tool in the diagnosis and management of children with congenital cardiac malformations. Unlike adults, children will not tolerate transoesophageal echocardiography under light sedation. This study was undertaken, therefore, to evaluate the safety and efficacy of deep sedation with propofol for transoesophageal echocardiography in children examined in an outpatient setting. Methods: This is a retrospective study of patients undergoing transoesophageal echocardiography with propofol given in bolus aliquots to achieve a level of sedation adequate to insert the transoesophageal echocardiographic probe and maintain sedation throughout the procedure. Results: We included a total of 118 patients, 57% being male, with a mean age of 12.9 years. Adequate sedation was achieved using a mean propofol dose of 8.3 milligrams per kilogram, with the dose per kilogram decreasing concomitant with increasing weight of the patient. Patients less than two years of age were intubated for the procedure. There were no clinically significant changes in cardiac function or haemodynamics. Non-intubated patients received supplemental oxygen prior to, or just after, the onset of sedation, with transient hypoxaemia observed in one-fifth. Complications were rare, with minor problems occurring in 7.6%, and major ones in 4%. Conclusions: Transoesophageal echocardiography can be performed on an outpatient basis in children with a wide spectrum of congenital cardiac malformations, and propofol is an ideal sedative agent in this setting. Although not common, preparations must be made for significant haemodynamic and respiratory complications. In our study, we intubated all the children under 2 years of age.

(Accepted September 2 2005)


Key Words: Paediatric cardiology; anaesthesia, aliquot.

Correspondence:
c1 Correspondence to: Christopher R. Mart, Paediatric Cardiology – Primary Children's Medical Center, 100 North Medical Drive, Suite 1500, Salt Lake City, Utah 84113, USA. Tel: +1 801 588 2600; Fax: +1 801 588 2612; E-mail: christopher.mart@ihc.com