Propofol Use in Israeli PICUs

Area of Science:

• Pediatric critical care medicine
• Anesthesiology and pain management
• Pharmacology and drug safety

Background:

• Current Israeli recommendations limit propofol use by age and require anesthesiologist supervision for procedural sedation.
• Propofol is frequently administered in Pediatric Intensive Care Units (PICUs) in Israel, indicating a gap between guidelines and practice.

Purpose of the Study:

• To investigate the current practices and perceptions regarding propofol use in Israeli PICUs.
• To assess the extent of off-label propofol administration and identify physician attitudes towards its expanded use in pediatric patients.

Main Methods:

• A questionnaire survey was distributed to physicians in PICUs across Israel.
• Data collected included patterns of propofol use, dosage, duration, encountered adverse effects, and opinions on expanding indications.

Main Results:

• Propofol is used for induction (100%), procedural sedation (70%), and ongoing ICU sedation (12%) in responding PICUs.
• Most participants limited infusions to 24 hours (88%) but 40% used it without dose limits; 25% reported adverse events.
• Physicians supported expanding propofol indications beyond current restrictions, with ketamine, fentanyl, and midazolam as common alternatives.

Conclusions:

• Off-label propofol use is a common and accepted practice in Israeli PICUs.
• Physicians find propofol valuable for sedation in pediatric critical care, advocating for its use in short durations and low doses by skilled personnel.