Abstract
Background Children with Acute Lymphoid Leukaemia (ALL) have to undergo multiple invasive procedures during which they are sedated with propofol. Clinicians suppose that patients seem to have a higher need of propofol for successive sedations, which might indicate tolerance to propofol. Better knowledge about propofol dosing schemes is needed in children receiving repeated sedations. Objective To investigate if and to what extent dose increases of propofol occur. Design and methods A retrospective observational cohort study was performed including children aged 1 to 21 years old with ALL who received a minimum of 5 sedations during the study period (Jan-Aug 2021). A database was built containing the induction and maintenance dose, duration of sedation and following covariates; age, sex, attending clinician and administered comedication (alfentanil, clonidine, acetaminophen). The dosing day (days between first and subsequent sedations) was plotted against the total propofol dose (μg/ kg/min). A linear mixed model analysis was performed in the statistical program R. Results A total of 93 patients (mean = 8.5 years) and 910 sedations were included. A significant increase in propofol dose was found. The statistical analyses showed a crude association of the dosing day with total propofol dose with 0.180 as regression coefficient (confidence interval [CI]: 0.088-0.271; P = 0.001), which represents the propofol dose increase per incremental dosing day. The covariates age, sex and alfentanil and acetaminophen as comedication had a significant influence on the total propofol dose. The covariate adjusted association showed a regression coefficient of 0.169 (CI: 0.076-0.263; P = 0.001). Conclusion In this study we observed an increase in propofol dose in paediatric ALL patients who received multiple sedations. To optimize clinical care in paediatric sedations, prospective studies are needed to confirm our finding on the need for higher propofol doses and whether this is caused by developing tolerance to the drug.
| Translated title of the contribution | The need for dose increases of propofol in children diagnosed with ALL when undergoing repeated sedations for invasive procedures - a clinical care evaluation: A retrospective observational cohort study in the Princess Maxima Center for paediatric oncology |
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| Original language | Dutch |
| Pages (from-to) | 19-26 |
| Number of pages | 8 |
| Journal | Pharmaceutisch Weekblad |
| Volume | 158 |
| Issue number | 44 |
| Publication status | Published - 3-Nov-2023 |