Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports

Area of Science:

• Pediatric critical care medicine
• Pharmacology and toxicology
• Pediatric intensive care

Background:

• Sedation is commonly used in pediatric intensive care units (PICUs) for intubated children.
• Propofol is a widely used anesthetic and sedative agent in pediatric populations.
• Understanding potential adverse effects of sedative agents is crucial for patient safety.

Observation:

• This case series reviewed five children (4 weeks to 6 years) with upper respiratory tract infections admitted to the PICU and requiring mechanical ventilation.
• All five children received propofol for sedation.
• A consistent clinical pattern emerged across all cases.

Findings:

• Children exhibited progressive metabolic acidosis, brady-arrhythmia, and myocardial failure unresponsive to resuscitation.
• Lipaemic serum was observed in all children after propofol administration.
• These clinical features and laboratory findings were atypical for the underlying respiratory infections and not explained by viral myocarditis.

Implications:

• Propofol sedation may be a potential contributing factor in the deaths of critically ill children with respiratory infections.
• Further investigation is warranted to elucidate the specific mechanisms of propofol-induced toxicity in this vulnerable population.
• This study highlights the importance of vigilant monitoring for adverse events associated with propofol in pediatric patients.