Dosage scheme for propofol in children under 3 years of age

Background: Propofol is a well-known drug for adults for total intravenous anaesthesia. Since 1999, the use of propofol has been approved for children less than 3 years of age. However, a suitable dosage scheme for these age groups was not available. The purpose of this study was to describe our clinical experience with the use of a new dosage scheme for propofol in patients under 3 years of age, based on experimental data and known pharmacological principles in children. Methods: A pilot study of 50 patients undergoing TIVA was performed to adapt the existing adult dosage scheme to the requirements of the younger population. Total number and time of administration of boluses and time to awakening were registered and used as criteria to adjust the dosage scheme. The subsequent dosage scheme was then evaluated in 2271 children undergoing anaesthesia for various procedures. Usual anaesthetic parameters were measured to monitor the safety of the patient: ECG, O₂ saturation, respiratory frequency and blood pressure. Most of the patients were mechanically ventilated; only 15% were breathing spontaneously. Results: Overall, few side effects were recorded [bradycardia (12%), blood pressure fall (8%), desaturation (1%)], which were easily countered by routine measures. Conclusions: This dosage scheme provides safe and smooth anaesthesia in children less than 3 years of age and is therefore a useful tool for a TIVA technique in small children.