I heard of it, but saw it finally - Propofol for ______!

[DrAmir0078]

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Hello Fellows,
I hope you are doing well, first of all "HAPPY ANNIVERSARY Anesthesiologists/Anesthetist and all in the field", yesterday was October 16th, and I truly hope you enjoyed your day if you observe/celebrate it (Do you?)!

It has been 2 weeks since I started my residency in Anesthesia, I can tell how heavy !
From OR day time to ICU night rounds' shifts !

The Teaching center is different, good stuff compared to my previous training hospital during my SHO, but I am still drawn with ABG Analysis (Thanks for Geeky Medics to help me get into the subject easily); and what made my title weird, is that my previous training hospital Seniors were cautious of using Propofol for children, so the induction protocol as I am seeing recently in this training center with Ketamine 2 - 3 mg/kg; Propofol 2-3 mg/kg (dosages are variable); Atropine (sometimes and it depends), and then the patient goes into deep sleep, then Isoflurane inhalation starts (since we are short of Sevoflurane) !

My question is !

Your experience with Propofol in Pediatrics !

Do you recommended with infants below 1 month?

What is your criteria or your protocols !

I am listening !

Love and Peace

 

[WholeLottaGame7]

Hello Fellows,
I hope you are doing well, first of all "HAPPY ANNIVERSARY Anesthesiologists/Anesthetist and all in the field", yesterday was October 16th, and I truly hope you enjoyed your day if you observe/celebrate it (Do you?)!

It has been 2 weeks since I started my residency in Anesthesia, I can tell how heavy !
From OR day time to ICU night rounds' shifts !

The Teaching center is different, good stuff compared to my previous training hospital during my SHO, but I am still drawn with ABG Analysis (Thanks for Geeky Medics to help me get into the subject easily); and what made my title weird, is that my previous training hospital Seniors were cautious of using Propofol for children, so the induction protocol as I am seeing recently in this training center with Ketamine 2 - 3 mg/kg; Propofol 2-3 mg/kg (dosages are variable); Atropine (sometimes and it depends), and then the patient goes into deep sleep, then Isoflurane inhalation starts (since we are short of Sevoflurane) !

My question is !

Your experience with Propofol in Pediatrics !

Do you recommended with infants below 1 month?

What is your criteria or your protocols !

I am listening !

Love and Peace

Propofol is not "approved" by our regulatory body for use in small children, but then again, most of the drugs we use aren't. Exceedingly difficult to do clinical trials on infants.

We use it all the time, including in neonates. The question you have to ask is "what am I using it for?" You don't need it strictly for amnesia on induction, as a neonate will not remember regardless of what you do. If they are comfortable and not moving, you have accomplished your objective. Many of the neonates I take care of, especially the sick ones, will get a narcotic/paralytic induction, maybe with a little volatile after intubation.

Most of the time we use propofol in neonates is for things like airway evals, where we need a combination of a native airway, anesthesia, and spontaneous respirations. Kids will take huge infusion doses, like 300-350mcg/kg/min and still breath spontaneously.

The older the kid gets, the more likely it is that I would use propofol for an IV induction. Ketamine (plus a benzo) is also a reasonable option. Kids will often take a higher dose than adults. 2-3mg/kg is reasonable. I'll even give higher (4-5mg/kg+) if the plan is to intubate without paralytic.

Atropine occasionally I'll give prophylactically in small/sick neonates, otherwise only if I run into trouble.

 

[DrAmir0078]

Propofol is not "approved" by our regulatory body for use in small children, but then again, most of the drugs we use aren't. Exceedingly difficult to do clinical trials on infants.

We use it all the time, including in neonates. The question you have to ask is "what am I using it for?" You don't need it strictly for amnesia on induction, as a neonate will not remember regardless of what you do. If they are comfortable and not moving, you have accomplished your objective. Many of the neonates I take care of, especially the sick ones, will get a narcotic/paralytic induction, maybe with a little volatile after intubation.

Most of the time we use propofol in neonates is for things like airway evals, where we need a combination of a native airway, anesthesia, and spontaneous respirations. Kids will take huge infusion doses, like 300-350mcg/kg/min and still breath spontaneously.

The older the kid gets, the more likely it is that I would use propofol for an IV induction. Ketamine (plus a benzo) is also a reasonable option. Kids will often take a higher dose than adults. 2-3mg/kg is reasonable. I'll even give higher (4-5mg/kg+) if the plan is to intubate without paralytic.

Atropine occasionally I'll give prophylactically in small/sick neonates, otherwise only if I run into trouble.

Thanks for your insight !