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.
