Do We Need a Fluid Bolus? The Necessary Refinement of Pediatric Propofol Sedation - a Quality Improvement Project.

Background: Propofol is commonly used for pediatric MRIs to minimize patient movement. At our institution, intensivists typically administer a prophylactic 20 ml/kg saline bolus to maintain blood pressure (BP) during propofol sedation. This quality improvement project assessed whether a 10 ml/kg and a completely eliminated saline bolus are as effective as the standard 20 ml/kg bolus in completing pediatric propofol sedation and maintaining Mean Arterial Pressure (MAP).

Methods: We reviewed pediatric propofol sedations over an 18 month period in which pediatric intensivists administered the standard 20 ml/kg saline bolus, a reduced 10 ml/kg bolus, and no saline bolus. Successful sedation meant completing the MRI without complications.

Results: 172 patients aged 19 months to 16 years were assessed. The percentage of successful sedations with a 20 ml/kg bolus, 10 ml/kg bolus, and no saline bolus was 92%, 100%, and 91%, respectively. There was a statistically significant higher average MAP in the 0 ml/kg group than in the 10 and 20 ml/kg cohorts (p = 0.002). No patients required an additional bolus to maintain blood pressure.

Conclusions: The preservation of hemodynamic stability without a saline bolus supports the literature that the saline bolus can be safely reduced during pediatric propofol sedation for MRI.