A retrospective comparison of infants and children sedated using propofol or dexmedetomidine has implicated propofol with the more rapid induction of anaesthesia and quicker recovery from sedation, researchers reported here at the 2015 Annual Meeting of the Pediatric Academic Societies (PAS).
However, while propofol may be an alternative to dexmedetomidine, its benefits come with the necessity for greater airway management.
Propofol and dexmedetomidine are both popular choices for the sedation of paediatric patients. However, their comparative success in terms of the speed sedation is achieved, how quickly the effects of sedation wear off, and the adverse consequences is unclear.
The current study retrospectively collected data from paediatric patients (birth to 17 years) who were sedated in the same paediatric unit between 2011 and 2013. During the earlier period of the study, dexmedetomidine was the main drug of choice and propofol was used more predominantly from mid-2012 onward.
Patients sedated with a combination of drugs, including propofol and/or dexmedetomidine, were excluded.
The 2,432 children comprised 1,503 who received propofol and 929 who received dexmedetomidine.
The mean induction time for propofol and dexmedetomidine was 60.6 ± 23.5 and 69.5 ± 22.6 minutes, respectively (P < .001). The mean recovery time in the same respective order was 34.3 ± 11.3 and 65.6 ± 26.3 minutes (P < .001). The total sedation time in the same respective order was 94.5 ± 25.7 and 135.1 ± 33.8 minutes (P < .001).
Additional loading dose prior to the start of the study in the propofol group (47.9%) and the dexmedetomidine group (18.7%) was also significantly different (P < .001).
Airway management was necessary for 145 patients receiving propofol (9.2%), compared with 20 patients receiving dexmedetomidine (2.2%; P < .001).
The frequencies of adverse events including apnoea for longer than 15 seconds, unexpected change in heart rate or blood rate, vomiting, and bradycardia were not statistically significantly different between groups.
“The use of propofol led to significantly faster induction and recovery times compared with dexmedetomidine,” wrote Nicole Schacherer, MD, Eastern Virginia Medical School, Norfolk, Virginia, and colleagues in their poster presentation. “There was a statistically significant increased need for airway management in the propofol group, but without increase in frequency of adverse events, compared with the dexmedetomidine group.”
The researchers concluded that propofol is a reasonable alternative to dexmedetomidine for efficient sedation, with a clinically acceptable profile.
They note that the necessity for an additional loading dose in the propofol group should be looked into, with the aim of formulating a more accurate loading dose for paediatric patients.
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