Propofol infusion in children.

Abstract

a!. Metabolic acid(osis attd fatal msocardial failure after propofol infusion in children: five case rcports. B.lI' 1992;305: 61 3-6. (1 September.) 2 O'Flahertv D. Catania A, Krishnan S (icsecke AH, Lipton J. Differential effects of total anaesthesia sersus inhalational anaestltesia on neurttendocrinc and immunc reactions during standardized surgical stress. EutrJAtaltasih/sh lOt) :S:A41S.

Propofol infusion syndrome

“…Many case reports highlight the refractory nature of this condition to intravenous fluid volume support and the use of escalating doses of inotropes [2, 4, 6, 8-10, 12, 24]. Limited success has been achieved with cardiac pacing (both transvenous and external) [2,12,[27][28][29][30][31][32]. Two reports have recorded the successful use of extracorporeal membrane oxygenation (ECMO) for oxygenation and circulatory support [31,32].…”

“…This was a hallmark publication and proposed a link between propofol infusions and mortality. Following this, a child (20 months old) with epiglottitis developed PRIS associated with a propofol infusion (mean rate 7.4 mg.kg )1 .h )1 ) over 56 h [28].…”

“…Two reports have recorded the successful use of extracorporeal membrane oxygenation (ECMO) for oxygenation and circulatory support [31,32]. Haemodialysis or haemofiltration has been advocated to decrease the blood levels of metabolic acids and lipids, and has been the most effective treatment of severe PRIS when combined with cardiorespiratory support [13,19,[27][28][29][30][31][32].…”

“…The mechanisms by which this syndrome occurs have not been elucidated but there is in vitro evidence that suggests impaired mitochondrial function [27]. The management of patients with this syndrome involves cardiovascular support with cardiac pacing and haemofiltration [27][28][29][30][31][32][33]. The aim of this article is to review the clinical features, pathophysiology and management of propofol infusion syndrome (PRIS).…”

A case of propofol toxicity: further evidence for a causal mechanism

“…In 1992, the United States Food and Drugs Authority (FDA) Advisory Committee (Anesthetic and Life Support Drugs) concluded that propofol had no direct link to deaths in pediatric ICUs and no identifiable link to adverse cardiac events in children or adults. However, there are at least 10 further case reports of propofol sedation associated with acidosis and arrhythmia in patients less than 18 years of age (3,5,14–20). Three of these survived (3,5,18) two having been treated with hemoperfusion (3,5).…”