Skip to main content
SpringerLink
Log in

Propofol for Sedation of the Critically Ill Child

  • Chapter
  • First Online:
Sedation and Analgesia for the Pediatric Intensivist

  • 869 Accesses

Abstract

Propofol is an intravenous anesthetic medication with favorable pharmacokinetic properties which include rapid onset, titratable depth of sedation, and rapid offset. Its major dose-dependent side effects include respiratory depression and hypotension. It is frequently administered for procedural sedation and anesthesia in pediatrics, but its use as a continuous sedative infusion for critically ill children is limited by safety concerns, specifically the rare but serious risk of propofol-related infusion syndrome. With these concerns in mind, continuous sedation with propofol for a limited period of time can be an excellent choice for certain pediatric patient populations, including children who require deep but brief sedation, children with increased intracranial pressure, and children in need of adjunctive palliative sedation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Bibliography

  1. Khurmi N, Patel P, Kraus M, Trentman T. Pharmacologic considerations for pediatric sedation and anesthesia outside the operating room: a review for anesthesia and non-anesthesia providers. Paediatr Drugs. 2017;19:435–46.

    Article  Google Scholar 

  2. Devlin JW, Roberts RJ. Pharmacology of commonly used analgesics and sedatives in the ICU: benzodiazepines, propofol, and opioids. Anesthesiol Clin. 2011;29:567–85.

    Article  CAS  Google Scholar 

  3. Wunsch H, Kahn JM, Kramer AA, Rubenfeld GD. Use of intravenous infusion sedation among mechanically ventilated patients in the United States. Crit Care Med. 2009;37:3031–9.

    Article  CAS  Google Scholar 

  4. Kamat PP, McCracken CE, Gillespie SE, et al. Pediatric critical care physician-administered procedural sedation using propofol: a report from the Pediatric Sedation Research Consortium Database. Pediatr Crit Care Med. 2015;16:11–20.

    Article  Google Scholar 

  5. Ahlen K, Buckley CJ, Goodale DB, Pulsford AH. The ‘propofol infusion syndrome’: the facts, their interpretation and implications for patient care. Eur J Anaesthesiol. 2006;23:990–8.

    Article  CAS  Google Scholar 

  6. Diedrich DA, Brown DR. Analytic reviews: propofol infusion syndrome in the ICU. J Intensive Care Med. 2011;26:59–72.

    Article  Google Scholar 

  7. Hsu B, Brazelton T. Off-label medication use in an academic hospital pediatric critical care unit. WMJ. 2009;108:343–8.

    Google Scholar 

  8. Heaton PC, Schuchter J, Lannon CM, Kemper AR. Impact of drug label changes on propofol use in pediatrics for moderate conscious sedation. Clin Ther. 2011;33:886–95.

    Article  Google Scholar 

  9. Trapani G, Altomare C, Liso G, Sanna E, Biggio G. Propofol in anesthesia. Mechanism of action, structure-activity relationships, and drug delivery. Curr Med Chem. 2000;7:249–71.

    Article  CAS  Google Scholar 

  10. Reed MD, Yamashita TS, Marx CM, Myers CM, Blumer JL. A pharmacokinetically based propofol dosing strategy for sedation of the critically ill, mechanically ventilated pediatric patient. Crit Care Med. 1996;24:1473–81.

    Article  CAS  Google Scholar 

  11. Jasiak KD, Phan H, Christich AC, Edwards CJ, Skrepnek GH, Patanwala AE. Induction dose of propofol for pediatric patients undergoing procedural sedation in the emergency department. Pediatr Emerg Care. 2012;28:440–2.

    Article  Google Scholar 

  12. Alletag MJ, Auerbach MA, Baum CR. Ketamine, propofol, and ketofol use for pediatric sedation. Pediatr Emerg Care. 2012;28:1391–5; quiz 6-8.

    Article  Google Scholar 

  13. Patel KN, Simon HK, Stockwell CA, et al. Pediatric procedural sedation by a dedicated nonanesthesiology pediatric sedation service using propofol. Pediatr Emerg Care. 2009;25:133–8.

    Article  Google Scholar 

  14. Hassan NE, Betz BW, Cole MR, et al. Randomized controlled trial for intermittent versus continuous propofol sedation for pediatric brain and spine magnetic resonance imaging studies. Pediatr Crit Care Med. 2011;12:e262–5.

    Article  Google Scholar 

  15. Klein SM, Hauser GJ, Anderson BD, et al. Comparison of intermittent versus continuous infusion of propofol for elective oncology procedures in children. Pediatr Crit Care Med. 2003;4:78–82.

    Article  Google Scholar 

  16. Hollman GA, Schultz MM, Eickhoff JC, Christenson DK. Propofol-fentanyl versus propofol alone for lumbar puncture sedation in children with acute hematologic malignancies: propofol dosing and adverse events. Pediatr Crit Care Med. 2008;9:616–22.

    Article  Google Scholar 

  17. Milius EM, Papademetrious TR, Heitlinger LA. Retrospective review of propofol dosing for procedural sedation in pediatric patients. J Pediatr Pharmacol Ther. 2012;17:246–51.

    Google Scholar 

  18. Smuszkiewicz P, Wiczling P, Przybylowski K, et al. The pharmacokinetics of propofol in ICU patients undergoing long-term sedation. Biopharm Drug Dispos. 2016;37:456–66.

    Article  CAS  Google Scholar 

  19. McFarlan CS, Anderson BJ, Short TG. The use of propofol infusions in paediatric anaesthesia: a practical guide. Paediatr Anaesth. 1999;9:209–16.

    CAS  Google Scholar 

  20. Barr J, Egan TD, Sandoval NF, et al. Propofol dosing regimens for ICU sedation based upon an integrated pharmacokinetic-pharmacodynamic model. Anesthesiology. 2001;95:324–33.

    Article  CAS  Google Scholar 

  21. Bailie GR, Cockshott ID, Douglas EJ, Bowles BJ. Pharmacokinetics of propofol during and after long-term continuous infusion for maintenance of sedation in ICU patients. Br J Anaesth. 1992;68:486–91.

    Article  CAS  Google Scholar 

  22. Bodenham A, Shelly MP, Park GR. The altered pharmacokinetics and pharmacodynamics of drugs commonly used in critically ill patients. Clin Pharmacokinet. 1988;14:347–73.

    Article  CAS  Google Scholar 

  23. Devlin JW, Mallow-Corbett S, Riker RR. Adverse drug events associated with the use of analgesics, sedatives, and antipsychotics in the intensive care unit. Crit Care Med. 2010;38:S231–43.

    Article  CAS  Google Scholar 

  24. Bjelland TW, Klepstad P, Haugen BO, Nilsen T, Dale O. Effects of hypothermia on the disposition of morphine, midazolam, fentanyl, and propofol in intensive care unit patients. Drug Metab Dispos. 2013;41:214–23.

    Article  CAS  Google Scholar 

  25. Marik PE. Propofol: therapeutic indications and side-effects. Curr Pharm Des. 2004;10:3639–49.

    Google Scholar 

  26. Fleck T, Schubert S, Ewert P, Stiller B, Nagdyman N, Berger F. Propofol effect on cerebral oxygenation in children with congenital heart disease. Pediatr Cardiol. 2015;36:543–9.

    Article  Google Scholar 

  27. Morgan DJ, Campbell GA, Crankshaw DP. Pharmacokinetics of propofol when given by intravenous infusion. Br J Clin Pharmacol. 1990;30:144–8.

    Article  CAS  Google Scholar 

  28. Sahyoun C, Krauss B. Clinical implications of pharmacokinetics and pharmacodynamics of procedural sedation agents in children. Curr Opin Pediatr. 2012;24:225–32.

    Article  CAS  Google Scholar 

  29. Cravero JP, Beach ML, Blike GT, Gallagher SM, Hertzog JH, Pediatric Sedation Research C. The incidence and nature of adverse events during pediatric sedation/anesthesia with propofol for procedures outside the operating room: a report from the Pediatric Sedation Research Consortium. Anesth Analg. 2009;108:795–804.

    Article  CAS  Google Scholar 

  30. Zhang Q, Yu Y, Lu Y, Yue H. Systematic review and meta-analysis of propofol versus barbiturates for controlling refractory status epilepticus. BMC Neurol. 2019;19:55.

    Article  Google Scholar 

  31. Claassen J, Hirsch LJ, Emerson RG, Mayer SA. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam: a systematic review. Epilepsia. 2002;43:146–53.

    Article  CAS  Google Scholar 

  32. Kelly DF, Goodale DB, Williams J, et al. Propofol in the treatment of moderate and severe head injury: a randomized, prospective double-blinded pilot trial. J Neurosurg. 1999;90:1042–52.

    Article  CAS  Google Scholar 

  33. Ravussin P, Guinard JP, Ralley F, Thorin D. Effect of propofol on cerebrospinal fluid pressure and cerebral perfusion pressure in patients undergoing craniotomy. Anaesthesia. 1988;43 Suppl:37–41.

    Article  CAS  Google Scholar 

  34. Roback MG, Carlson DW, Babl FE, Kennedy RM. Update on pharmacological management of procedural sedation for children. Curr Opin Anaesthesiol. 2016;29(Suppl 1):S21–35.

    Article  CAS  Google Scholar 

  35. Mahmood S, Mahmood O, El-Menyar A, Asim M, Al-Thani H. Predisposing factors, clinical assessment, management and outcomes of agitation in the trauma intensive care unit. World J Emerg Med. 2018;9:105–12.

    Article  Google Scholar 

  36. Charriere M, Ridley E, Hastings J, Bianchet O, Scheinkestel C, Berger MM. Propofol sedation substantially increases the caloric and lipid intake in critically ill patients. Nutrition. 2017;42:64–8.

    Article  CAS  Google Scholar 

  37. Devlin JW, Lau AK, Tanios MA. Propofol-associated hypertriglyceridemia and pancreatitis in the intensive care unit: an analysis of frequency and risk factors. Pharmacotherapy. 2005;25:1348–52.

    Article  CAS  Google Scholar 

  38. Abdelmalik PA, Rakocevic G. Propofol as a risk factor for ICU-acquired weakness in septic patients with acute respiratory failure. Can J Neurol Sci. 2017;44:295–303.

    Article  Google Scholar 

  39. Martin JM, Gillingham MB, Harding CO. Use of propofol for short duration procedures in children with long chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) or trifunctional protein (TFP) deficiencies. Mol Genet Metab. 2014;112:139–42.

    Article  CAS  Google Scholar 

  40. Krajcova A, Lovsletten NG, Waldauf P, et al. Effects of Propofol on cellular bioenergetics in human skeletal muscle cells. Crit Care Med. 2018;46:e206–e12.

    Article  CAS  Google Scholar 

  41. Frohlich D, Trabold B, Rothe G, Hoerauf K, Wittmann S. Inhibition of the neutrophil oxidative response by propofol: preserved in vivo function despite in vitro inhibition. Eur J Anaesthesiol. 2006;23:948–53.

    Article  CAS  Google Scholar 

  42. Devlin JW, Skrobik Y, Gelinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46:e825–e73.

    Article  Google Scholar 

  43. Deeter KH, King MA, Ridling D, Irby GL, Lynn AM, Zimmerman JJ. Successful implementation of a pediatric sedation protocol for mechanically ventilated patients. Crit Care Med. 2011;39:683–8.

    Article  Google Scholar 

  44. Dreyfus L, Javouhey E, Denis A, Touzet S, Bordet F. Implementation and evaluation of a paediatric nurse-driven sedation protocol in a paediatric intensive care unit. Ann Intensive Care. 2017;7:36.

    Article  Google Scholar 

  45. Wu J, Mahmoud M, Schmitt M, Hossain M, Kurth D. Comparison of propofol and dexmedetomidine techniques in children undergoing magnetic resonance imaging. Paediatr Anaesth. 2014;24:813–8.

    Article  Google Scholar 

  46. Ruokonen E, Parviainen I, Jakob SM, et al. Dexmedetomidine versus propofol/midazolam for long-term sedation during mechanical ventilation. Intensive Care Med. 2009;35:282–90.

    Article  CAS  Google Scholar 

  47. Best KM, Boullata JI, Curley MA. Risk factors associated with iatrogenic opioid and benzodiazepine withdrawal in critically ill pediatric patients: a systematic review and conceptual model. Pediatr Crit Care Med. 2015;16:175–83.

    Article  Google Scholar 

  48. Best KM, Wypij D, Asaro LA. Curley MA and randomized evaluation of sedation titration for respiratory failure study I. Patient, process, and system predictors of iatrogenic withdrawal syndrome in critically ill children. Crit Care Med. 2017;45:e7–e15.

    Article  Google Scholar 

  49. Kondili E, Alexopoulou C, Xirouchaki N, Georgopoulos D. Effects of propofol on sleep quality in mechanically ventilated critically ill patients: a physiological study. Intensive Care Med. 2012;38:1640–6.

    Article  CAS  Google Scholar 

  50. Bienert A, Kusza K, Wawrzyniak K, et al. Assessing circadian rhythms in propofol PK and PD during prolonged infusion in ICU patients. J Pharmacokinet Pharmacodyn. 2010;37:289–304.

    Article  CAS  Google Scholar 

  51. Lewis SR, Schofield-Robinson OJ, Alderson P, Smith AF. Propofol for the promotion of sleep in adults in the intensive care unit. Cochrane Database Syst Rev. 2018;1:CD012454.

    Google Scholar 

  52. Lonardo NW, Mone MC, Nirula R, et al. Propofol is associated with favorable outcomes compared with benzodiazepines in ventilated intensive care unit patients. Am J Respir Crit Care Med. 2014;189:1383–94.

    Article  CAS  Google Scholar 

  53. Wang H, Wang C, Wang Y, et al. Sedative drugs used for mechanically ventilated patients in intensive care units: a systematic review and network meta-analysis. Curr Med Res Opin. 2019;35:435–46.

    Article  CAS  Google Scholar 

  54. Skrobik Y, Duprey MS, Hill NS, Devlin JW. Low-dose nocturnal Dexmedetomidine prevents ICU delirium. A randomized, placebo-controlled trial. Am J Respir Crit Care Med. 2018;197:1147–56.

    Article  CAS  Google Scholar 

  55. Riker RR, Shehabi Y, Bokesch PM, et al. Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009;301:489–99.

    Article  CAS  Google Scholar 

  56. Pandharipande PP, Pun BT, Herr DL, et al. Effect of sedation with dexmedetomidine vs lorazepam on acute brain dysfunction in mechanically ventilated patients: the MENDS randomized controlled trial. JAMA. 2007;298:2644–53.

    Article  CAS  Google Scholar 

  57. Bryczkowski SB, Lopreiato MC, Yonclas PP, Sacca JJ, Mosenthal AC. Risk factors for delirium in older trauma patients admitted to the surgical intensive care unit. J Trauma Acute Care Surg. 2014;77:944–51.

    Article  Google Scholar 

  58. Morita T, Akechi T, Sugawara Y, Chihara S, Uchitomi Y. Practices and attitudes of Japanese oncologists and palliative care physicians concerning terminal sedation: a nationwide survey. J Clin Oncol. 2002;20:758–64.

    Article  Google Scholar 

  59. McWilliams K, Keeley PW, Waterhouse ET. Propofol for terminal sedation in palliative care: a systematic review. J Palliat Med. 2010;13:73–6.

    Article  Google Scholar 

  60. Anghelescu DL, Hamilton H, Faughnan LG, Johnson LM, Baker JN. Pediatric palliative sedation therapy with propofol: recommendations based on experience in children with terminal cancer. J Palliat Med. 2012;15:1082–90.

    Article  Google Scholar 

  61. Parke TJ, Stevens JE, Rice AS, et al. Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. BMJ. 1992;305:613–6.

    Article  CAS  Google Scholar 

  62. Roberts RJ, Barletta JF, Fong JJ, et al. Incidence of propofol-related infusion syndrome in critically ill adults: a prospective, multicenter study. Crit Care. 2009;13:R169.

    Article  Google Scholar 

  63. Fong JJ, Sylvia L, Ruthazer R, Schumaker G, Kcomt M, Devlin JW. Predictors of mortality in patients with suspected propofol infusion syndrome. Crit Care Med. 2008;36:2281–7.

    Article  CAS  Google Scholar 

  64. Linko R, Laukkanen A, Koljonen V, Rapola J, Varpula T. Severe heart failure and rhabdomyolysis associated with propofol infusion in a burn patient. J Burn Care Res. 2014;35:e364–7.

    Article  Google Scholar 

  65. Mijzen EJ, Jacobs B, Aslan A, Rodgers MG. Propofol infusion syndrome heralded by ECG changes. Neurocrit Care. 2012;17:260–4.

    Article  CAS  Google Scholar 

  66. Mali AR, Patil VP, Pramesh CS, Mistry RC. Hyperkalemia during surgery: is it an early warning of propofol infusion syndrome? J Anesth. 2009;23:421–3.

    Article  Google Scholar 

  67. Vollmer JP, Haen S, Wolburg H, et al. Propofol related infusion syndrome: ultrastructural evidence for a mitochondrial disorder. Crit Care Med. 2018;46:e91–e4.

    Article  Google Scholar 

  68. Riera AR, Uchida AH, Schapachnik E, Dubner S, Filho CF, Ferreira C. Propofol infusion syndrome and Brugada syndrome electrocardiographic phenocopy. Cardiol J. 2010;17:130–5.

    Google Scholar 

  69. Krajcova A, Waldauf P, Andel M, Duska F. Propofol infusion syndrome: a structured review of experimental studies and 153 published case reports. Crit Care. 2015;19:398.

    Article  Google Scholar 

  70. Diaz JH, Prabhakar A, Urman RD, Kaye AD. Propofol infusion syndrome: a retrospective analysis at a level 1 trauma center. Crit Care Res Pract. 2014;2014:346968.

    Google Scholar 

  71. Veldhoen ES, Hartman BJ, van Gestel JP. Monitoring biochemical parameters as an early sign of propofol infusion syndrome: false feeling of security. Pediatr Crit Care Med. 2009;10:e19–21.

    Article  Google Scholar 

  72. Sumi C, Okamoto A, Tanaka H, et al. Propofol induces a metabolic switch to glycolysis and cell death in a mitochondrial electron transport chain-dependent manner. PLoS One. 2018;13:e0192796.

    Article  CAS  Google Scholar 

  73. Jorens PG, Van den Eynden GG. Propofol infusion syndrome with arrhythmia, myocardial fat accumulation and cardiac failure. Am J Cardiol. 2009;104:1160–2.

    Article  Google Scholar 

  74. Kruessell MA, Udink ten Cate FE, Kraus AJ, Roth B, Trieschmann U. Use of propofol in pediatric intensive care units: a national survey in Germany. Pediatr Crit Care Med. 2012;13:e150–4.

    Article  Google Scholar 

  75. Rosenfeld-Yehoshua N, Klin B, Berkovitch M, Abu-Kishk I. Propofol use in Israeli PICUs. Pediatr Crit Care Med. 2016;17:e117–20.

    Article  Google Scholar 

  76. Koriyama H, Duff JP, Guerra GG, Chan AW, Sedation W, Analgesia T. Is propofol a friend or a foe of the pediatric intensivist? Description of propofol use in a PICU*. Pediatr Crit Care Med. 2014;15:e66–71.

    Article  Google Scholar 

  77. Schroeppel TJ, Fabian TC, Clement LP, et al. Propofol infusion syndrome: a lethal condition in critically injured patients eliminated by a simple screening protocol. Injury. 2014;45:245–9.

    Article  Google Scholar 

  78. Ramaiah R, Lollo L, Brannan D, Bhananker SM. Propofol infusion syndrome in a super morbidly obese patient (BMI = 75). Int J Crit Illn Inj Sci. 2011;1:84–6.

    Article  Google Scholar 

  79. Da-Silva SS, Wong R, Coquillon P, Gavrilita C, Asuncion A. Partial-exchange blood transfusion: an effective method for preventing mortality in a child with propofol infusion syndrome. Pediatrics. 2010;125:e1493–9.

    Article  Google Scholar 

  80. Levin PD, Levin V, Weissman C, Sprung CL, Rund D. Therapeutic plasma exchange as treatment for propofol infusion syndrome. J Clin Apher. 2015;30:311–3.

    Article  Google Scholar 

  81. Guitton C, Gabillet L, Latour P, et al. Propofol infusion syndrome during refractory status epilepticus in a young adult: successful ECMO resuscitation. Neurocrit Care. 2011;15:139–45.

    Article  CAS  Google Scholar 

  82. Mtaweh H, Bayir H, Kochanek PM, Bell MJ. Effect of a single dose of propofol and lack of dextrose administration in a child with mitochondrial disease: a case report. J Child Neurol. 2014;29:NP40–6.

    Article  Google Scholar 

  83. Finsterer J, Frank M. Propofol is mitochondrion-toxic and may unmask a mitochondrial disorder. J Child Neurol. 2016;31:1489–94.

    Article  Google Scholar 

  84. Savard M, Dupre N, Turgeon AF, Desbiens R, Langevin S, Brunet D. Propofol-related infusion syndrome heralding a mitochondrial disease: case report. Neurology. 2013;81:770–1.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA

    Leslie A. Dervan & R. Scott Watson

  2. Center for Clinical and Translational Research; Seattle Children’s Research Institute, Seattle, WA, USA

    Leslie A. Dervan

  3. Center for Child Health, Behavior, and Development; Seattle Children’s Research Institute, Seattle, WA, USA

    R. Scott Watson

Authors
  1. Leslie A. Dervan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Scott Watson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leslie A. Dervan .

Editor information

Editors and Affiliations

  1. Associate Professor of Pediatrics, Emory University School of Medicine, Department of Pediatrics, Division of Pediatric Critical Care Medicine, Children’s Healthcare of Atlanta at Egleston, Atlanta, GA, USA

    Pradip P. Kamat

  2. Professor of Pediatrics/Pediatric Critical Care, University of Louisville, “Just For Kids” Critical Care Center, Norton Children’s Hospital, Louisville, KY, USA

    John W. Berkenbosch

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Dervan, L.A., Watson, R.S. (2021). Propofol for Sedation of the Critically Ill Child. In: Kamat, P.P., Berkenbosch, J.W. (eds) Sedation and Analgesia for the Pediatric Intensivist. Springer, Cham. https://doi.org/10.1007/978-3-030-52555-2_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-52555-2_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-52554-5

  • Online ISBN: 978-3-030-52555-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation