Aug 2026· The Journal of Pediatric Pharmacology and Therapeutics· Vol 31 4, pp.
540-548
· 0 citations· 36 references
Medicine
TL;DR
Propofol was safely used to facilitate extubation and decreased baseline sedative exposure when used for sedation washout in a complex critically ill pediatric population and was tolerated by most patients at doses commonly exceeding guideline- recommended maximum rate and duration.
Abstract
Objectives
Propofol is used sparingly in pediatrics owing to the risk of propofol-related infusion syndrome (PRIS). The objective of this study is to evaluate the safety of propofol in pediatrics and describe its effectiveness at facilitating extubation and decreasing concomitant sedation.
Methods
This retrospective, descriptive study evaluated critically ill children who received continuous propofol infusions for at least 12 consecutive hours while admitted to pediatric, congenital cardiac, or neonatal intensive care units. The primary outcome was PRIS incidence. Secondary outcomes included change from baseline in laboratory parameters, discontinuation due to adverse effects, change in sedative requirements following sedation washout, and successful extubation.
Results
From January 1, 2019, to November 1, 2023, a total of 100 children received 120 courses of propofol infusions. The median infusion rate was 106 mcg/kg/min (IQR, 68-149) and 27.5% of courses exceeded 48 hours in duration. No PRIS events were identified. Patients experienced a moderate, non-duration-dependent increase in triglycerides, with no impact on aspartate aminotransferase (AST)/alanine aminotransferase (ALT) concentrations; 11.7% of infusions were discontinued for adverse effects. No children self-extubated while on propofol when used for peri-extubation (N = 49). Opioid and benzodiazepine requirements were decreased by 17% and 26% from baseline, respectively, during a 24-hour period following sedation washout (N = 26).
Conclusions
Propofol was tolerated by most patients at doses commonly exceeding guideline-recommended maximum rate and duration. Propofol was safely used to facilitate extubation and decreased baseline sedative exposure when used for sedation washout in a complex critically ill pediatric population.
Propofol-related infusion syndrome (PRIS), first described in 1990, is a rare and dangerous condition caused by high-dose (> 4 mg/kg/hour) and prolonged (> 48 hours) administration of propofol in mechanically ventilated patients. This condition is characterized by a progressive constellation of multi-organ failure. The main clinical presentations include severe metabolic and lactic acidosis, rhabdomyolysis, acute liver failure, lipemic blood, hyperkalemia, and cardiovascular impairment or marked bradycardia, which can lead to cardiac arrest. The mechanism of PRIS remains unclear and is likely controversial. The most effective way to prevent PRIS is to remain vigilant and maintain a high level of suspicion during prolonged propofol administration. Early recognition of clinical manifestations, prompt discontinuation of propofol infusion, and timely initiation of supportive management are essential to reduce morbidity and mortality associated with PRIS. Understanding the underlying pathophysiology and identifying patients at high risk may improve preventive strategies and optimize outcomes in critically ill patients receiving prolonged propofol infusion.
Hori Hariyanto, Carla Oktaviani Pandrya, Kevin Anderson Surya· Cermin Dunia Kedokteran· 0 citations
Propofol total intravenous anesthesia (TIVA) is increasingly used in pediatric practice, but concerns persist regarding delayed emergence after prolonged infusions due to its context-sensitive half-time and interindividual variability in pharmacokinetics and pharmacodynamics, especially in younger children with immature pharmacokinetic profiles. This prospective study was conducted at a tertiary university hospital between August 2022 and June 2023. We enrolled 47 children aged 12 months to 15 years undergoing elective surgery lasting ≥ 120 min who received target-controlled infusion (TCI) of propofol using the Paedfusor model. Patients were stratified into four age groups: 12-23 months, 2-6 years, 7-11 years, and 12-15 years. The primary outcome was extubation time. Secondary outcomes included total propofol requirements and BIS less than 30. Extubation times did not differ significantly among groups (mean 12.1-17.8 min; ANOVA p > 0.05) and demonstrated statistical equivalence across age groups (all pairwise differences within ± 10 min). Neither age nor propofol dose predicted extubation time (R² = 0.052, p = 0.314). Propofol requirements decreased significantly with age (Spearman's r = - 0.80, p < 0.0001), while Ce at first purposeful movement converged across groups (1.9-2.3 µg/mL). In pediatric patients undergoing medium-duration surgery with propofol-based TCI anesthesia, extubation times were comparable across age groups despite higher propofol requirements in younger children. A nonsignificant trend toward more delayed extubation was observed in the youngest subgroups, which should be interpreted with caution given the small sample sizes.
Issada Jindawatthana, P. Sriswasdi, Wiriya Maisat et al.· Scientific Reports· 0 citations
Background In the intensive care unit, sedation plays a crucial role in managing critically ill patients, particularly those undergoing invasive procedures. Common sedatives such as propofol and sufentanil are administered to ensure comfort and alleviate pain among intensive care unit patients. However, prolonged sedation is associated with risks, including delayed recovery, increased susceptibility to infections, and challenges in monitoring critical conditions. This study investigated the effect of sedation using only propofol, only sufentanil, and a combination of both on short-term outcomes in intensive care unit patients. Methods In total, 300 adult intensive care unit patients, both postoperative and nonpostoperative, were included in this retrospective study. The observation period was 10 days from intensive care unit admission. In addition to baseline clinical data, intensive care unit length of stay, delta Sequential Organ Failure Assessment score, occurrence of pulmonary infiltrates on chest X-ray, onset of acute kidney injury, and need for reintubation were assessed as study outcomes. Results Results showed that patients sedated using sufentanil alone or in combination with propofol had a longer length of intensive care unit stay and exhibited higher delta Sequential Organ Failure Assessment scores, which worsened over a 10-day period compared with those who were not sedated or administered propofol alone. Additionally, new pulmonary infiltrates occurred more frequently in patients sedated with a combination of propofol and sufentanil than in those who were administered propofol alone or no sedation. Patients who were administered sufentanil alone were reintubated more often than those who were not sedated or were administered propofol alone. Conclusions The use of sufentanil, alone or combined with propofol, is associated with poorer short-term outcomes in ICU patients. These findings highlight the need for careful evaluation of sedation strategies in critically ill patients.
Luca Scarsella, Contrino Rita, El-Masri Dschamil et al.· Journal of International Med...· 0 citations
Propofol may be considered as a rescue option in selected refractory cases managed by experienced teams; however, given the low to very low certainty of available evidence, findings should be interpreted cautiously and supported by institutional protocols and further prospective research.
Luís Almeida-Jardim, P. Reis-Pina· Palliative Medicine· 0 citations
Background: Induction of general anesthesia in high-
‘
risk patients is often associated with significant
hemodynamic instability. Propofol and etomidate are commonly used induction agents, but their cardiovascular
and endocrine effects differ.
Aim: To compare propofol and etomidate with respect to hemodynamic stability, adverse effects, and stress
hormone response during induction of anesthesia in high-risk patients.
Methodology: This prospective randomized comparative study included 50 ASA II–III patients undergoing
elective surgery under general anesthesia. Patients were randomly allocated to receive propofol (n=25) or
etomidate (n=25) for induction. Hemodynamic parameters (SBP, DBP, MAP), adverse effects, and serum cortisol
levels were recorded at predefined intervals.
Results: Demographic characteristics were comparable between groups. Propofol was associated with a
significant and sustained reduction in SBP, DBP, and MAP following induction and intubation (p<0.001), with a
higher incidence of hypotension (36%). Etomidate maintained better hemodynamic stability but was associated
with myoclonus (20%) and significant transient suppression of serum cortisol levels postoperatively (p<0.001),
which normalized within 24 hours.
Conclusion: Etomidate provides superior hemodynamic stability compared to propofol during induction in highrisk patients, with transient adrenal suppression. It may be preferred when cardiovascular stability is a primary
concern.
Pankaj Kumar, Khushbu Rani, Muni Lal Gupta et al.· International Journal of Pha...· 0 citations
Ciprofol was associated with significantly lower PAED scores, indicating reduced EA severity, along with faster emergence, improved recovery quality and higher parental satisfaction compared with propofol, suggesting that ciprofol may be an effective alternative to propofol in pediatric outpatient dental anesthesia.
Yaqiu Zhang, Long Wu, Zhenzhen Gao et al.· Drug Design, Development and...· 1 citation