Propofol is an IV hypnotic that is made in a soy-based emulsion containing soybean oil, egg lecithin, and glycerol. It has a very rapid onset time (10-50 seconds) and a brief duration of action making it ideal for ED sedation. Children have a more rapid metabolism of propofol than adults. Propofol has been shown to be safe and effective for Pediatric ED sedation in several studies.
Pearls on Propofol
- Dosing is 1mg/kg bolus than 0.5 mg/kg IV q 1-2 min until desired sedation occurs
- Due to high lipid concentration can cause pain at injection site in up to 70% of patients. This can be prevented by applying a rubber tourniquet well above IV site and injecting 0.5 mg/kg of lidocaine 30 seconds before injecting the propofol.
- Use is contraindicated in those with allergies to Eggs, Soy, or sulfites, or those with mitochondrial disorders
- PRIS (Propofol Infusion Syndrome) was described in 1992 with case reports of children dying due to metabolic acidosis, rhabdomyolysis, and refractory heart failure when receiving high doses (>4mg/kg/h) for >48 hours. And it is more associated with children < 4 years old.
- So while safe for pediatric procedural sedation don't use propofol as a drip for intubated children.
References
Lopez M, Beltran G. Pediatric Procedural Sedation. Pediatric Emergency Medicine Reports. Dec 2008.