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Propofol Use in Pediatric Patients With Severe Cancer Pain at the End of Life

Children's Hospitals and Clinics of Minnesota, Department of Hematology/Oncology, Minneapolis

Erin Grund, BS

Heather Quammen, RN, CNP

Children's Hospitals and Clinics of Minnesota, Department of Hematology/Oncology, Minneapolis

Blaine Miller, MD

Paul McCormick, MD

Department of Pediatric Anesthesia at Children's Hospitals and Clinics of Minnesota, Minneapolis

Bruce Bostrom, MD

Children's Hospitals and Clinics of Minnesota, Department of Hematology/Oncology, 2525 Chicago Ave S, Minneapolis, MN 55404; phone: (612) 813-6282; fax: (612) 813-6325; bruce.bostrom{at}childrensmn.org

This article describes the use and effectiveness of adjuvant propofol for pain control for pediatric oncology patients at the end of life. All patients experienced severe pain and agitation, not well controlled by continuous infusion opioids and benzodiazepines. Upon starting propofol, most patients had a temporary stabilization in the dose of opioids with subjective improvement in pain control, increased alertness, and improved ability to interact. Propofol infusions were continued until death in most patients. Two patients received propofol infusions at home. Subsequent increases in opioids in 6 patients and propofol in all patients were required for optimal pain control. Adverse effects included agitation in 5 patients and hallucinations in 2, which were controllable with benzodiazepines. One patient developed severe tetany, requiring propofol interruption; propofol was successfully restarted at a lower dose with an adjuvant benzodiazepine. The authors conclude that propofol is a useful and tolerable adjuvant agent for pain management in pediatric oncology patients at the end of life. It is a useful adjuvant if pain is unresponsive to continuous infusion opioids or if rapidly escalating doses of opioids are required.

Key Words: propofol • cancer pain • pediatric oncology • pain control • palliative care • end of life

Journal of Pediatric Oncology Nursing, Vol. 24, No. 1, 29-34 (2007)
DOI: 10.1177/1043454206296026


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