Lauren Smiley, PGY2

Children's Health Children's Medical Center Dallas, Dallas, Texas

Objectives: 

1. Understand the mechanism of action, approved indications, and potential adverse effects of propofol.
2. Discuss the theoretical benefit of using propofol for continuous sedation in difficult to manage pediatric patients.
3. Describe the effect of propofol infusions on concomitant opioid and benzodiazepine continuous infusion requirements for the management of continuous sedation in critically ill pediatric patients.

Abstract:

Evaluation of propofol washout on opioid and benzodiazepine requirements of critically ill pediatric patients
Lauren Smiley, PharmD, Courtney Long, PharmD, Proshad Efune, MD

INTRODUCTION
Achieving safe and effective sedation remains a challenging clinical problem for critically ill children in the intensive care unit. At Children’s Health Children’s Medical Center Dallas, propofol is commonly used in the intensive care units for the management of continuous sedation in order to decrease opioid and benzodiazepine requirements in select patients. This practice is anecdotally referred to as a “propofol washout”. The theory behind this practice is that replacing opioids and benzodiazepines with propofol will washout the patients’ receptors thereby allowing sedation and analgesia to be restarted at lower doses or to decrease opioid and benzodiazepine continuous infusion rates to facilitate extubation. While there is literature surrounding the efficacy and safety of propofol use in pediatric patients, the data describing the use of propofol for this specific indication is scarce. Additional analysis of the efficacy of propofol washouts could help guide prescribers’ future practice and potentially alter the management of continuous sedation in critically ill pediatric patients. The primary objective of this study is to describe the effect of propofol infusions on concomitant opioid and benzodiazepine continuous infusion requirements. The secondary objective is to describe the rate of successful extubations, clinical adverse effects, and length of intensive care unit and hospital length of stay.

METHODS
This is a retrospective cohort study of critically ill pediatric patients admitted to the intensive care unit (e.g., cardiovascular intensive care unit, pediatric intensive care unit, or trauma/neuro intensive care unit) at Children’s Health Children’s Medical Center Dallas between June 1, 2013 and May 31, 2018. All children admitted to the intensive care unit who received an opioid and/or benzodiazepine infusion in addition to a propofol infusion for the management of continuous sedation will be included in the study. Patients will be excluded if they received propofol for any of the following indications: increased intracranial pressure, procedural sedation, or status epilepticus. Patient demographics and clinical data to be collected includes: age, gender, race, weight, comorbid conditions, duration of opioid and/or benzodiazepine exposure, cumulative opioid and/or benzodiazepine dose, duration of propofol infusion, cumulative propofol dose, adverse drug effects, extubation outcomes, length of intensive care unit stay, and length of hospital stay.

RESULTS
Results will be submitted within final slides.

CONCLUSION
Conclusion will be submitted within final slides.

Handout Slides:

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