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CMAJ • March 18, 2003; 168 (6)
© 2003 Canadian Medical Association or its licensors

Letters
Correspondance

Propofol syndrome in children

Mark W. Crawford*, Bruce G. Dodgson{dagger}, Helen H.K. Holtby{ddagger} and W. Lawrence Roy§

*Director of Research, Department of Anesthesia, The Hospital for Sick Children, Toronto, Ont.; {dagger}Director of Quality Management, Department of Anesthesia, The Hospital for Sick Children, Toronto, Ont.; {ddagger}Director of Anesthesia, Department of Anesthesia, The Hospital for Sick Children, Toronto, Ont.; §Chief of Anesthesia, Department of Anesthesia, The Hospital for Sick Children, Toronto, Ont.

Eric Wooltorton's report about propofol1 reiterates the well-known fact that the use of propofol for sedation in critically ill children has been associated with a life-threatening adverse reaction characterized by metabolic acidosis, hemodynamic instability, multiorgan failure, lipemia, hepatomegaly and rhabdomyolysis.2,3 Wooltorton speculates that this reaction, which he refers to as the "propofol syndrome," may be less common when the drug is used in children for procedural sedation or for induction or maintenance of general anesthesia. However, he contends that "significant harm can come from off-label use of agents whose pediatric safety profile is incomplete" and that "the known and theoretical risks of propofol should be explained to parents."

At the Hospital for Sick Children, propofol has been used in approximately 100 000 pediatric patients for sedation and general anesthesia without a single occurrence of the "propofol syndrome." This rate is less than the incidence of major perioperative complications.4 Our experience is similar to that at other centres,5,6 and thus the actual risk, if it exists at all, is minimal. Furthermore, a causal relation between propofol anesthesia and the syndrome has never been established.2,3,7

The suggestion that the "propofol syndrome" may occur in the context of single bolus administration or short-term infusion in children is incorrect. Accordingly, we stand by our practice of not citing this issue when we inform parents or guardians of the risks associated with propofol anesthesia in the preoperative interview.

Mark W. Crawford Director of Research Bruce G. Dodgson Director of Quality Management Helen H.K. Holtby Director of Cardiac Anesthesia W. Lawrence Roy Chief of Anesthesia Department of Anesthesia The Hospital for Sick Children Toronto, Ont.

References

  1. Wooltorton E. Propofol: contraindicated for sedation of pediatric intensive care patients. CMAJ 2002; 167(5):507.[Free Full Text]
  2. Parke TJ, Stevens JE, Rice AS, Greenway CL, Bray RJ, Smith PJ, et al. Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. BMJ 1992;305:613-6.
  3. Cray SH, Robinson BH, Cox PN. Lactic acidemia and bradyarrhythmia in a child sedated with propofol. Crit Care Med 1998;26:2087-92.[Medline]
  4. Cohen MM, Cameron CB, Duncan PG. Pediatric anesthesia morbidity and mortality in the perioperative period. Anesth Analg 1990;70:160-7.[Abstract/Free Full Text]
  5. Hatch DJ. Propofol-infusion syndrome in children. Lancet 1999;353:1117-8.[Medline]
  6. Reed MD, Blumer JL. Propofol bashing: The time to stop is now! Crit Care Med 1996;24:175-6.[Medline]
  7. Mehta N, DeMunter C, Habibi P, Nadel S, Britto J. Short-term propofol infusions in children. Lancet 1999;354:866-7.[Medline]



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Arrogance of Doctors and Propofol
Deborah j Wood
CMAJ, 12 May 2003 [Full text]
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