Age-related differences in propofol dosing for procedural sedation in the Emergency Department.

BACKGROUND: Propofol dose requirements may differ in the elderly due to age-related changes in pharmacokinetic or pharmacodynamic variables. OBJECTIVE: The objective of this study was to determine the effect of patient age on propofol dose required for procedural sedation in the Emergency Department (ED). METHODS: This was a retrospective cohort study conducted in a tertiary hospital ED. Adult patients who underwent procedural sedation in the ED using propofol were grouped a priori by age into three categories: 18-40 years, 41-64 years, and ≥65 years. The median induction dose and total dose of propofol required for the procedure was compared between the three age group categories. Multivariate linear regression analyses were used to adjust for confounders. RESULTS: A total of 170 patients were included in the final analyses: 18-40 years (n = 66), 41-64 years (n = 59), and ≥65 years (n = 45). The median induction dose was 1.4, 1, and 0.9 mg/kg, respectively; and the median total propofol dose was 2, 1.7, and 1.2 mg/kg, respectively. The ≥65 year-old group required significantly less propofol (mg/kg) for induction (compared to the 18-40-year-old group) and for the entire procedure (compared to all other groups) (p < 0.001). In the multivariate linear regression analyses, patient age was negatively predictive of induction dose (coefficient -0.011, 95% confidence interval [CI] -0.017 to -0.005) and total dose (coefficient -0.014, 95% CI -0.022-0.007) after adjusting for confounders. CONCLUSION: Elderly patients may require lower doses of propofol for procedural sedation in the ED, compared to younger adults.

Induction dose of propofol for pediatric patients undergoing procedural sedation in the emergency department.

OBJECTIVE: This study aimed to determine if patient age is an independent predictor of the propofol dose required for the induction of sedation in pediatric patients for procedures performed in the emergency department (ED). METHODS: This is a retrospective study conducted in an academic, tertiary ED between May 2005 and October 2009. Medical records of patients younger than 18 years who received propofol for procedural sedation were evaluated. Data collected included patient demographics, procedure type, propofol doses administered, time to sedation induction, pain scores before procedure, opioid administration, and adverse effects. Factors predictive of propofol induction dose were analyzed using linear regression analyses. RESULTS: Eighty-eight patients were included in the final analyses. The mean age was 11 years (range, 1-17 years), and 75% were male. The mean induction dose required was 2.1 ± 1.3 mg/kg using a median of 3 boluses (interquartile range, 2-4). The mean time to induction was 3.9 ± 4.2 minutes. In the linear regression analyses (R = 0.07), patient age was inversely predictive of the induction dose (in milligram per kilogram) of propofol (coefficient = -0.074; P = 0.013). Sex, race, procedure type, pain score before procedure, and opioid administration were not predictive of induction dose. Transient respiratory depression occurred in 13.6% and hypotension occurred in 8% of patients, without further complications. CONCLUSIONS: In pediatric patients undergoing procedural sedation in the ED, age is an independent predictor of the dose of propofol required for induction of sedation. Therefore, younger patients may require higher doses by body weight (in milligram per kilogram).