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Two questions.  First, how do you get past the "propofol" phobia and use this in the ED but not as procedural sedation?  Second, propofol can be very painful when administer peripherally?  Do you use some lido?
Mike Falk

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> On Oct 30, 2013, at 7:44 PM, "Meckler, Garth" <[log in to unmask]> wrote:
> 
> Hey Pam, we published a case-control series of low-dose propofol for pediatric migraine (in PEC) - the idea came from two large series in adults with chronic headache.
> We are currently starting to enroll for a prospective RCT based on our small series and review of the adult literature.
> 
> No one knows for sure in children what dose might be effective.  In adults, 10-20 mg IV bolus was used, repeated every 10 minutes until pain free (usually 2-3 doses required).  At this dose, no patient fell asleep and there were no complications.
> We extrapolated from these data and chose a sub-anesthetic dose of 0.3-0.5 mg/kg IV push.  In our series, no patient fell asleep or had any abnormalities of BP or POX, though we monitored according to sedation guidelines.  
> Our study was small and non-randomized, so no definitive evidence exists for this treatment modality, hence the RCT....anecdotally, I can share our approach was to give IV bolus doses separated by about 10 minutes (repeat dosing based on VAS pain score and complete absence of objective or subjective drug effect between doses); we had excellent success even among those who had failed all other standard therapies for migraine.  Those who responded did so immediately - the typical progression was 10/10 pain before treatment, 8/10 after one bolus, 4/10 after a second and 0/10 after a third.  We do not know the rates of recurrence, but they are high with current standard treatment options including triptans and dopamine antagonists.
> 
> Happy to send copies of the article or the references from the adult literature upon request. 
> 
> Garth Meckler, MD, MSHS
> BC Children's Hospital / University of British Columbia
> 
> 
>> On Oct 30, 2013, at 4:31 PM, Pamela MURPHY <[log in to unmask]> wrote:
>> 
>> I had an interesting case last week of a 15yo male presenting with headache and altered level of consciousness with combativeness.  He had no fever, no trauma and no history of migraines although family history was positive for migraines.  Workup, including drug screen and CT of head, was negative.  In plans for admission and eval by peds neuro I did an LP with propofol sedation thinking about an article I had seen recently on propofol for migraines.  Amazingly, the teen "woke up" and was perfectly normal post sedation.  He was admitted for observation and peds neuro eval and was discharged with a diagnosis of complex migraine.
>> 
>> So, this raises a few questions.
>> 
>> Are you using propofol in the ED for migraines?  
>> If so, first line or after traditional treatment failure?
>> What dose do you use?
>> 
>> Thanks for input!
>> 
>> Pam Murphy
>> 
>> 
>> 
>> 
>> Pamela S Murphy, MD
>> Mendy's Place
>> John C. Lincoln Deer Valley Hospital
>> 
>> 
>> 
>> 
>> 
>> 
>>                         
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> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html