Review article: Safety profile of propofol for paediatric procedural sedation in the emergency department

Area of Science:

• Emergency Medicine
• Pediatric Anesthesiology
• Pharmacology

Background:

• Propofol's use for pediatric procedural sedation (PPS) is growing, yet concerns about adverse events have limited its application in emergency departments (EDs).
• Existing data on propofol's safety profile in pediatric patients undergoing procedural sedation outside the operating room is fragmented.

Purpose of the Study:

• To systematically review the literature on propofol use for PPS outside the operating theatre.
• To determine the adverse event rate associated with propofol for PPS and compare it with other sedation agents.

Main Methods:

• A systematic literature review was conducted, analyzing studies published between 1966 and 2008.
• Included were 60 studies encompassing 17,066 instances of pediatric propofol sedation in various hospital settings.

Main Results:

• The incidence of complications included desaturation (9.3%), apnea (1.9%), assisted ventilation (1.4%), and hypotension (15.4%).
• Serious adverse events like unplanned intubation (0.02%) and death were extremely rare; no aspiration or intra-sedation emesis occurred.
• Minor adverse events were reversible, without long-term sequelae, and occurred at rates similar to other sedation agents.

Conclusions:

• Propofol for pediatric procedural sedation is associated with a low rate of minor, reversible adverse events.
• Its safety profile is comparable to alternative agents, supporting its expanded use in emergency departments for PPS.
• Careful patient and procedure selection can further mitigate the already low risks of major adverse events.