Is propofol (2,6-diisopropylphenol) suitable for use in pediatric patients?

From the Guidelines

Yes, propofol can be used in pediatric patients for sedation and anesthesia, but it requires careful monitoring due to the risk of respiratory depression and cardiovascular effects. The medication is commonly administered for procedures requiring short-term sedation, induction and maintenance of general anesthesia, and sedation in intensive care settings. According to a prospective, blinded, randomized, controlled trial comparing IV midazolam and propofol for painful procedures in the ED 1, propofol is effective and safe, with a shorter recovery time than midazolam. The typical induction dose ranges from 2.5-3.5 mg/kg in children, while maintenance doses are usually 100-200 mcg/kg/min titrated to effect.

Some key considerations when using propofol in pediatric patients include:

• Careful monitoring of respiratory and cardiovascular function, as children may experience more pronounced effects compared to adults
• Risk of propofol infusion syndrome, particularly with high doses (>4 mg/kg/hr) or prolonged use (>48 hours), which can cause metabolic acidosis, rhabdomyolysis, cardiac dysfunction, and potentially death
• Lack of analgesic properties, requiring separate pain management when needed
• Administration only by clinicians trained in airway management and in settings with appropriate monitoring and resuscitation equipment

Studies have shown that propofol is safe and effective for use in pediatric patients, with efficacy rates of 100% in some studies 1. However, careful patient selection and diligent monitoring are necessary to minimize the risk of adverse effects. As noted in a prospective observational study of ED procedures 1, propofol is effective and safe, but requires careful monitoring and administration by trained clinicians.

In terms of specific dosing, a prospective, randomized, controlled trial comparing IV midazolam and propofol for painful procedures in the ED found that a bolus dose of 1 mg/kg followed by an infusion of 4-6 mg/kg/h was effective and safe 1. However, the dosage may vary depending on the specific procedure and patient population, and should be titrated to effect. Overall, propofol can be a useful medication for sedation and anesthesia in pediatric patients, but requires careful monitoring and administration by trained clinicians.

From the FDA Drug Label

The safety and effectiveness of propofol injectable emulsion have been established for induction of anesthesia in pediatric patients aged 3 years and older and for the maintenance of anesthesia aged 2 months and older Propofol injectable emulsion is not recommended for the induction of anesthesia in patients younger than 3 years of age and for the maintenance of anesthesia in patients younger than 2 months of age as safety and effectiveness have not been established Propofol injectable emulsion is not indicated for use in pediatric patients for ICU sedation or for MAC sedation for surgical, nonsurgical or diagnostic procedures as safety and effectiveness have not been established

Key Points:

• Propofol is suitable for use in pediatric patients aged 3 years and older for induction of anesthesia and aged 2 months and older for maintenance of anesthesia.
• Propofol is not recommended for use in pediatric patients younger than 3 years for induction of anesthesia and younger than 2 months for maintenance of anesthesia.
• Propofol is not indicated for ICU sedation or MAC sedation in pediatric patients due to lack of established safety and effectiveness. 2

From the Research

Suitability of Propofol in Pediatric Patients

• Propofol can be used in pediatric patients, but it is crucial to administer it with caution, especially for prolonged sedation in intensive care units 3.
• The use of propofol in pediatric anesthesia and sedation has been increasing, and it is essential to educate non-anesthesiologists about its pharmacokinetics and pharmacodynamics 3.
• A study found that propofol sedation is safe and effective in pediatric patients undergoing diagnostic and therapeutic procedures, with a low incidence of adverse events 4.
• Another study confirmed that propofol sedation is safe for pediatric outpatient procedures, with a low rate of major complications 5.

Safety Considerations

• Propofol infusion syndrome (PRIS) is a concern in critically ill pediatric patients, but a study found no cases of PRIS in patients receiving propofol infusions at high doses and for extended periods 6.
• Propofol infusions can be hemodynamically tolerated in pediatric patients, and they can help reduce the need for other pain and sedation infusions 7.
• It is essential to monitor patients closely for signs of developing PRIS and to use propofol at dose rates of below 5 mg/kg per hour for prolonged sedation 3.

Administration Guidelines

• Propofol can be administered with a small dose of short-acting opioid, such as fentanyl, to minimize the risk of adverse events 3.
• A pediatric target-controlled system for propofol can help refine administration to infants and children 3.
• Propofol should be used with extreme caution in pediatric patients, and its administration should be guided by pharmacokinetic principles 3.