[Propofol infusion syndrome in children]

Area of Science:

• Anesthesiology and Critical Care Medicine
• Pediatric Critical Care
• Pharmacology

Context:

• Propofol is commonly used for sedation in critically ill children.
• Long-term propofol administration is associated with rare but severe adverse events.
• Propofol infusion syndrome (PRIS) presents a significant clinical challenge.

Purpose:

• To describe the characteristics, potential mechanisms, and clinical recommendations for propofol infusion syndrome.
• To highlight the risks of propofol in pediatric intensive care settings.
• To provide guidance on safe propofol usage in children.

Summary:

• Propofol infusion syndrome (PRIS) is a rare, fatal condition in critically ill children, characterized by cardiovascular collapse, metabolic acidosis, hepatomegaly, renal failure, and rhabdomyolysis.
• The syndrome is hypothesized to result from impaired mitochondrial free fatty acid metabolism, leading to energy imbalance and compromised cellular function in cardiac and peripheral muscles.
• Recommended precautions include cautious use in critically ill children and avoidance of doses exceeding 4 mg/kg/h, even for long-term anesthesia in healthy children.

Impact:

• Informed clinical practice regarding propofol use in pediatric populations.
• Enhanced awareness of PRIS risks and early recognition strategies.
• Potential reduction in PRIS incidence through adherence to safety guidelines.