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Published on: January 17, 2011
Continuous propofol infusion in 142 critically ill children
David N Cornfield1, Ken Tegtmeyer, Michael D Nelson
1Department of Pediatrics, Oregon Health and Sciences University, Portland, Oregon, USA. cornf001@umn.edu
Insights
Continuous intravenous propofol infusion is safe and effective for sedating critically ill children in pediatric intensive care units. This study found no adverse events associated with its use in 142 patients.
Area of Science:
- Pediatric Critical Care Medicine
- Pharmacology
- Anesthesiology
Background:
- Continuous intravenous propofol infusion is increasingly used in pediatric intensive care units (PICUs).
- Concerns regarding the safety of propofol infusion have been raised by previous case reports.
- This study aimed to evaluate the safety and efficacy of continuous propofol infusion in critically ill pediatric patients.
Purpose of the Study:
- To report the clinical experience with continuous intravenous propofol infusion in a cohort of critically ill children.
- To assess the safety profile of propofol when administered via continuous infusion in a pediatric intensive care setting.
Main Methods:
- Retrospective case series review of 142 critically ill children.
- Propofol administered via continuous intravenous infusion, not exceeding 50 microg/kg/min.
- Protocol allowed for hourly 1 mg/kg boluses; data collected from PICU and bone marrow transplant units.
Main Results:
- All 142 patients achieved adequate sedation.
- Continuous propofol infusion was not associated with metabolic acidosis or hemodynamic compromise.
- No instances of inadvertent extubation or central venous catheter dislodgement were reported.
Conclusions:
- Continuous intravenous propofol infusion is a safe and effective method for sedating critically ill infants and children.
- The study suggests that continuous propofol infusion rates should not exceed 67 microg/kg/min for extended periods.
Objective:
In recent years, continuous intravenous propofol infusion has been widely used in pediatric intensive care units. Several case reports have raised concerns about its safety. The objective of this study was to report our experience with continuous intravenous propofol in consecutive patients during an 18-month period.
Methods:
The study design was a retrospective review of a case series. Case was defined as a critically ill child who was treated with continuous intravenous propofol. The attending physician staff agreed to prescribe propofol via continuous intravenous infusion at a dose not to exceed 50 microg/kg/min. The protocol allowed for each patient to receive an additional intravenous bolus of propofol at a dose of 1 mg/kg no more than once per hour. The study entailed data collection from consecutive patients who were prescribed a continuous infusion of propofol in either the pediatric intensive care unit or bone marrow transplant unit.
Results:
Data from 142 patients were analyzed. Each patient enrolled was adequately sedated. Administration of propofol via continuous intravenous infusion was not associated with metabolic acidosis or hemodynamic compromise. No patient in the study group was inadvertently extubated or had a central venous catheter accidentally discontinued.
Conclusions:
Propofol can be safely and effectively used to provide sedation to critically ill infants and children. We speculate that continuous infusion of propofol for extended periods of time should not exceed 67 microg/kg/min.
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