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Propofol Requirements for Induction of Anesthesia in Children of Different Age Groups

Department of Anesthesia, Erasmus University (Division of Pediatric Anesthesia), Sophia Children's Hospital, Rotterdam, The Netherlands

To demonstrate any age-related differences in propofol requirements for induction of anesthesia, 150 healthy children aged 3–5 yr (n = 50), 6–9 yr (n = 50), and 10–15 yr (n = 50) scheduled for outpatient surgery were randomly assigned to receive an induction dose of propofol of 1.5, 2.0, 2.5, 3.0, or 3.5 mg/kg. To limit pain during injection, alfentanil (5 µg/kg) was administered before the propofol. Patients were classified as asleep or not asleep 30 s after the propofol. Incidence of excitation, injection pain, and apnea during induction of anesthesia were noted; arterial blood pressure and heart rate were recorded for 5 min after induction. More than 95% of the children were asleep in the dose groups receiving 2.5 mg/kg. The number of patients falling asleep after receiving 1.5 mg/kg of propofol increased significantly with increasing age (P < 0.05); the difference between the oldest and the youngest age groups was the most significant (P < 0.05). Significant decreases in mean arterial blood pressure and heart rate occurred after induction in all dose and age groups without any systematic intergroup differences. Apnea occurred more frequently in older children (P < 0.01) and with larger doses (P < 0.01). The most frequent side effect was erythema near the site of injection, and its occurrence was dose dependent. The authors conclude that 2.5 mg/kg of propofol, if preceded by 5 µg/kg of alfentanil, is an appropriate induction dose for children aged 3–15 yr and that the sleep response to 1.5 mg/kg is more in older children.

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