Abstracts

Rationale: Published literature on use of continuous propofol infusion for seizures in children remains limited due in part to decrease use by clinicians because of safety concerns. The objective of this study is to report our experience in children treated with continuous propofol infusion in the setting of acute repetitive and prolonged seizures. Methods: All consecutive children (= 21 years) who received propofol infusion in the setting of acute repetitive and prolonged seizures from Jan 2015 to Apr 2017 were identified retrospectively following a search of electronic medical records. Patients were identified by searching order sets (Power Plans) using 1) Power Plans including continuous propofol infusions and 2) key diagnoses such as epilepsy, seizure, altered mental status. Medical records were audited for demographics, seizure/epilepsy history, seizure duration, initial treatment, propofol dosing and duration, baseline and follow up vital signs, laboratory values and hospital/Intensive care unit (ICU) duration. Results: Results: 62 patients (M: F 1.2:1), median age 3 years (range: 3 mo. – 21 yrs.), with 64 episodes of acute repetitive or prolonged seizures received continuous propofol infusion starting in Emergency Department (ED) or ICU. Fifty percent of the patients (31/62) had new onset seizures while 18 (29%) had history of previous status epilepticus. 62/64 episodes were initially treated with benzodiazepines while 32 (50%) and 13 (20%) episodes respectively received a second and third non-benzodiazepine treatment prior to initiation of continuous propofol infusion. Mean time duration between estimated start of seizure and start of propofol infusion was 2.4 hrs. (range: 15 min – 8.5 hrs.). In 41 episodes (64%), propofol infusion was initiated in the ED prior to transferring to the ICU. Max propofol infusion rate ranged from 50 – 200 mcg/kg/min (mean: 121 mcg/kg/min) with mean duration of use 14 hrs. (range: 1.75 – 33 hrs.). Blood gases were drawn in 51 episodes (80%) while on propofol infusion. Two patients (3%) had evidence of metabolic acidosis (defined as venous blood pH = 7.25 with a concomitant PaCO2 = 45); both resolved without discontinuation of propofol or any pharmacological intervention. All patients had documented baseline and follow up vital signs. Heart rate remained stable and did not require any intervention. None of the patients received vasoactive agents before initiation of propofol, however in 2 patients (propofol max rate 100 and 200 mcg/kg/min respectively), a vasoactive agent was used during propofol infusion to manage hypotension. Creatine phosphokinase (CPK) levels were not followed routinely. No patient in this cohort required discontinuation of propofol due to adverse effects. Median duration of ICU and hospital stays were 36.75 hrs. (range: 11.75 hrs. – 20 days) and 65.75 hrs. (range: 21.75 hrs. – 34 days), respectively. Conclusions: Propofol infusion was safe when used in the setting of acute repetitive and prolonged seizures in children and was not associated with significant side effects including metabolic acidosis or hemodynamic instability. A larger prospective cohort is required confirm these findings.