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Propofol infusion syndrome in children

R J Bray1

  • 1Department of Anaesthesia, Royal Victoria Infirmary, Newcastle upon Tyne, UK.

Paediatric Anaesthesia
|December 4, 1998
PubMed

Insights

Propofol infusions for pediatric sedation may be linked to myocardial failure. This study investigated serious adverse events in 18 children, finding a significant association with long-term, high-dose propofol use in pediatric intensive care units.

Area of Science:

  • Pediatric Critical Care Medicine
  • Clinical Pharmacology
  • Anesthesiology

Background:

  • Propofol infusions were widely used for pediatric sedation in intensive care units (ICUs).
  • Reports of myocardial failure and deaths led to decreased propofol use.
  • Concerns arose that propofol might have been prematurely condemned.

Purpose of the Study:

  • To investigate serious adverse events associated with propofol infusions in children.
  • To identify common features among children experiencing adverse effects.
  • To assess the potential link between propofol administration and myocardial failure in a pediatric ICU setting.

Main Methods:

  • Retrospective review of 18 pediatric patients who received propofol infusions and experienced serious adverse effects.
  • Analysis of data from a specific ICU between 1987 and 1993.
  • Statistical analysis (Fisher's Exact Test) to determine the association between propofol dosage/duration and myocardial failure.

Main Results:

  • Three deaths from progressive myocardial failure occurred in a single ICU among children receiving long-term (>48h), high-dose (>4 mg.kg-1.h-1) propofol infusions.
  • Nine children received such infusions during the study period.
  • A significant association (P=0.0128) was found between long-term, high-dose propofol infusions and progressive myocardial failure.

Conclusions:

  • While a causative relationship could not be definitively proven, a significant association exists between long-term, high-dose propofol infusions and progressive myocardial failure in pediatric patients.
  • These findings warrant careful consideration of propofol administration protocols in pediatric ICUs.
  • Further research may be needed to elucidate the mechanisms and confirm causality.

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