P018: PROPOFOL REQUIREMENTS FOR PEDIATRIC SOLID ORGAN TRANSPLANT RECIPIENTS DURING PROCEDURAL SEDATION
Michael T Kuntz, MD, Gloria I Lopez-Hernandez, MD, Brent J Pfeiffer, MD, PhD, Amanda D Saab, MD; University of Miami, Jackson Memorial Hospital, and Holtz Children's Hospital
Introduction: Few studies assess differences in sedation needs of pediatric patients undergoing procedural sedation.(1-3) Aside from those studies of lung transplant recipients, no studies examine propofol dose requirements for pediatric patients with solid organ transplants undergoing procedural sedation. We noted that pediatric solid organ transplant recipients required higher propofol infusion rates during procedural sedation than non-transplant recipients. We sought to determine if there is a difference in sedation requirements, and if greater propofol doses were associated with immunosuppressants or systemic steroids.
Methods: We performed a retrospective chart review of anesthesia and sedation records for pediatric patients undergoing procedural sedation between November 14, 2015 and November 13, 2017. We included patients undergoing esophagogastroduodenoscopy (EGD), colonoscopy, liver or kidney biopsy, or combinations of those procedures. We excluded cases beginning under general anesthesia. Prior to statistical analysis, it was noted that isolated EGDs almost exclusively represented non-transplant patients, so isolated EGDs were ultimately excluded. We collected: age, weight, height, procedure, total propofol dose (mg), other anesthetics/analgesics, transplant type, immunosuppressive drugs, systemic steroids, and complications.
Results: Our final cohort included 423 encounters; 33% (n=138) involved solid organ transplant recipients. The most common types of transplant were multivisceral (n=57) and liver (n=37). Among transplant recipients, 99% (n=137) took immunosuppressant medications and 39% (n=54) took systemic steroids. Among non-transplant patients, 23% (n=66) took immunosuppressant medications and 6.3% (n=18) took systemic steroids. Combined EGD/colonoscopy was the most common procedure. No cases required conversion to general anesthesia.
Transplant recipients required higher propofol doses (mean±SE, mcg/kg/min) than non-transplant patients (344±13 vs. 242±9, p<0.0001). Immunosuppressants and systemic steroids were associated with higher propofol doses. Propofol dose was inversely related to patient age; this trend was stronger for non-transplant patients.
Discussion/Conclusion: Patients with solid organ transplants received more propofol than patients without solid organ transplants. Propofol dose decreased with age, but the transplant recipient always required more regardless of age. Similar to our study, Ho, et al demonstrated higher propofol doses for transplant recipients when examining lung transplant patients with cystic fibrosis.(2) Comparatively, our study is much larger and includes a broader range of pathologies and transplant types. Chhajed, et al also showed higher sedation requirements for transplant recipients, although they primarily studied midazolam and fentanyl doses.(1) Patients in our study received primarily propofol.
Our study demonstrates that pediatric patients with solid organ transplants undergoing procedures with sedation required greater propofol doses to achieve adequate sedation for procedural sedation. Further studies are necessary to determine the cause of the higher dose requirement.
1. Chhajed P, Aboyoun C, Chhajed T, Malouf M, Harrison G, Tamm M, et al. Sedative Drug Requirements during Bronchoscopy Are Higher in Cystic Fibrosis after Lung Transplantation. Transplantation. 2005;80:1081-5.
2. Ho C, Hayes D, Khosravi M, Splaingard M, Tumin D, Lloyd E. Sedation with Propofol for Bronchoscopy in Cystic Fibrosis Lung Transplant Recipients. Lung. 2018;196:435-9.
3. Moretto A, Zanella A, Ciceri V, Rota M, Scaravilli V, Beltrama V, et al. Induction Dosage of Propofol for Repeated Sedations in Children with Hematological Disorders. J Pediatr Hematol Oncol. 2018;40(5):e295-8.