Objectives: Given the variability and unpredictability of oral sedation, we aimed to determine the safety, efficacy and efficiency of intravenous propofol sedation in children with congenital heart disease undergoing transthoracic echocardiography.

Methods: Data from consecutive patients scheduled for echocardiograms from January 2005 to December 2008 were recorded prospectively. Sedation was initiated with sevoflurane, IV access secured and propofol infused at 100-200 mcg/kg/min. Patients breathed spontaneously with nasal cannula and end-tidal CO2 sampling. Vital signs were recorded at 5 minute intervals. Adverse events were documented, as were sedation time to echocardiogram, sedation duration and time to discharge.

Results: One hundred and ninety one records were analyzed. Median age was 24 months (3 months to 13 years) and mean weight 12.6 kg. Fifty one patients (27%) had a known genetic anomaly or developmental delay. Five had previously failed chloral hydrate sedation. Forty seven patients (25%) had single ventricle physiology. In two patients IV access proved impossible and sedation was continued with sevoflurane. Echocardiograms were completed in all patients. Mean time from sedation to echo, sedation duration, recovery room time and total hospital stay was 7, 61, 49 and 115 minutes respectively. Adverse events included hypotension (2) and bradycardia (1). In two patients a laryngeal mask was inserted electively (one with sleep apnea, one with known difficult airway), no patients required intubation.

Conclusions: Propofol sedation is a safe effective alternative to oral sedation in children with heart disease. With a low incidence of adverse events, it provides ideal conditions for transthoracic echocardiography.