Age-related differences in extubation time following propofol-based target-controlled infusion in pediatric medium-duration surgery: A prospective cohort study.

Abstract

Propofol total intravenous anesthesia (TIVA) is increasingly used in pediatric practice, but concerns persist regarding delayed emergence after prolonged infusions due to its context-sensitive half-time and interindividual variability in pharmacokinetics and pharmacodynamics, especially in younger children with immature pharmacokinetic profiles. This prospective study was conducted at a tertiary university hospital between August 2022 and June 2023. We enrolled 47 children aged 12 months to 15 years undergoing elective surgery lasting ≥ 120 min who received target-controlled infusion (TCI) of propofol using the Paedfusor model. Patients were stratified into four age groups: 12-23 months, 2-6 years, 7-11 years, and 12-15 years. The primary outcome was extubation time. Secondary outcomes included total propofol requirements and BIS less than 30. Extubation times did not differ significantly among groups (mean 12.1-17.8 min; ANOVA p > 0.05) and demonstrated statistical equivalence across age groups (all pairwise differences within ± 10 min). Neither age nor propofol dose predicted extubation time (R² = 0.052, p = 0.314). Propofol requirements decreased significantly with age (Spearman's r = - 0.80, p < 0.0001), while Ce at first purposeful movement converged across groups (1.9-2.3 µg/mL). In pediatric patients undergoing medium-duration surgery with propofol-based TCI anesthesia, extubation times were comparable across age groups despite higher propofol requirements in younger children. A nonsignificant trend toward more delayed extubation was observed in the youngest subgroups, which should be interpreted with caution given the small sample sizes.