Review article: Safety profile of propofol for paediatric procedural sedation in the emergency department

Abstract

The use of propofol for paediatric procedural sedation (PPS) is increasing because of its favourable pharmacodynamic profile. Its paediatric use has been limited in some ED (emergency departments) because of the perceived high rate of serious adverse events in comparison with other sedation agents. A systematic literature review of propofol use for PPS outside the operating theatre environment from 1966 to 2008 was carried out to profile the adverse event rate in comparison with other procedural sedation agents. Sixty studies with a total of 17,066 paediatric propofol sedations in a variety of hospital settings were identified. The incidence of complications were: desaturation 9.3%, apnoea 1.9%, assisted ventilation 1.4%, hypotension 15.4%, unplanned intubation 0.02%, emesis post procedure 0.14%, laryngospasm 0.1% and bradycardia 0.1%. There were no reported incidents of aspiration or emesis during sedation and there were no deaths associated with procedural propofol sedation. The use of propofol for PPS is associated with a low rate of minor adverse events that are all reversible with minimal intervention and do not produce long-term sequelae and occur at similar rates to minor adverse events experienced with other sedation agents. Major adverse events with propofol sedation are extremely rare and appropriate patient and procedure selection would decrease these risks further. The increasing use of propofol for ED PPS is supported by the current evidence because of its comparable adverse event rate to other agents.

What Works and What's Safe in Pediatric Emergency Procedural Sedation: An Overview of Reviews

“…From 2,882 unique references, 14 completed systematic reviews were included (Figure , Table ). Three protocols for in‐process reviews were identified on propofol and midazolam for procedural sedation and structured sedation programs in acute care settings; since the protocols provide no data they are not included in this review.…”

Empfehlungen und Standards für die Analgosedierung kinderkardiologischer Patienten

“…B. Propofol als Sedativum und einem zusätzlichen Analgetikum (z. B. Ketamin) in der Mehrzahl der kardiologischen Zentren bereits seit Jahren klinischer Standard [3] und in den kinderkardiologischen Zentren seit Jahren gelebte Praxis ist [2,[4][5][6]…”

“…Tiefe Analgosedierungen (≥Stufe III) erfordern für die Durchführung und Überwachung weitere, entsprechend qualifizierte personelle Unterstützung. Auf das bereits in der Kardiologie als effektiv und sicher etablierte sowie in den meisten kinderkardiologischen Zentren in der klinischen Praxis genutzte Konzept der "nurse-administered propofol sedation" wird ausdrücklich hingewiesen (NAPS, [3,6] Bei Gesundheitspflegern und -pflegerinnen mit Fachweiterbildung Intensivpflege oder Anästhesie oder auch langjährig erfahrenen Pflegern/Pflegerinnen im Bereich Kinderkardiologie bzw. Intensivmedizin kann von diesen erforderlichen Kenntnissen und Erfahrungen ausgegangen werden.…”

Paediatric procedural sedation within the emergency department

“…It can be used for short, painful procedures in combination with analgesia. Adverse events were rare in two paediatric series, with reported complications of hypotension (15.4%), desaturation (9.3%), apnoea (1.9%), assisted ventilation (1.4%), unplanned intubation (0.2%), emesis(0.14%), laryngospasm (0.1%), bradycardia (0.1%) and anaphylaxis in children with egg or soy allergies …”