Continuous propofol perfusion in critically ill children

Agudelo, Sandra; Mencía, Santiago; Faro, Ana Cristina Mancussi e; Escudero, Viviana de la Concepción García; Sanavia, Eva; López‐Herce, Jesús

doi:10.1016/j.medine.2011.11.007

Cited by 2 publications

(3 citation statements)

References 24 publications

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“…6 The pharmacokinetics of propofol are best described by a 3-compartment mammal model, with a rapidly equilibrant central compartment, a second larger peripheral compartment, and the third very large peripheral compartment. 12 Although this study is retrospective in nature and does utilize an historical cohort of patients, it strongly supports the judicious use of propofol for performing successful pediatric colonoscopy. In particular, the volume of the central compartment is much greater in children than in adults, with the consequence that children require higher induction and maintenance doses than adults to achieve the same propofol blood concentration.…”

Section: Discussionmentioning

confidence: 63%

“…10 It has to be used with caution because it can result in significant cardiovascular depression. 11 Its pharmacokinetics is altered in children, 12 with increased clearance and larger volumes of distribution relative to adults. 11 Its pharmacokinetics is altered in children, 12 with increased clearance and larger volumes of distribution relative to adults.…”

Section: Discussionmentioning

confidence: 99%

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Propofol for Pediatric Colonoscopy

Cohen

Glatstein

Scolnik

et al. 2014

American Journal of Therapeutics

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Successful colonoscopy includes full visualization of the terminal ileum, especially in inflammatory bowel disease when ileal biopsy is essential. In children, higher levels of anxiety and lack of cooperation often necessitate a deeper level of sedation. The aim of this study was to evaluate the effectiveness of propofol compared with midazolam and fentanyl for colonoscopy, and in accomplishing ileal and cecal intubation in particular. This was a retrospective cohort study comparing the rates of successful colonoscopy in patients receiving propofol with those receiving midazolam/fentanyl. Complete, successful, colonoscopy to the terminal ileum was achieved in 78% of propofol patients compared with 66% of the midazolam/fentanyl group (P=0.004). Endoscopy reaching the cecum, but not the terminal ileum, was achieved in 78% of propofol patients and 66% of midazolam/fentanyl patients. The use of propofol was associated with a statistically significant increase in the rate of successful colonoscopy reaching the terminal ileum.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Propofol for Pediatric Colonoscopy

Cohen

Glatstein

Scolnik

et al. 2014

American Journal of Therapeutics

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“…Furthermore, several meta-analyses showed that total intravenous anesthesia increased mortality compared with volatile anesthetic agents in cardiac surgery populations [15,16]. Although a randomized trial found an increase in the mortality rate among children receiving sedation with propofol in pediatric intensive care units [17], leading to safety warnings from the Food and Drug Administration [18], there are numerous reports on the use of propofol for long-term sedation in critically ill children [19][20][21]. We performed a meta-analysis of randomized controlled trials (RCTs) on propofol versus any comparator in postoperative and critically ill patients to test the hypothesis that propofol could increase mortality.…”

Section: Introductionmentioning

confidence: 99%

Propofol and survival: an updated meta-analysis of randomized clinical trials

et al. 2023

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Background Propofol is one of the most widely used hypnotic agents in the world. Nonetheless, propofol might have detrimental effects on clinically relevant outcomes, possibly due to inhibition of other interventions' organ protective properties. We performed a systematic review and meta-analysis of randomized controlled trials to evaluate if propofol reduced survival compared to any other hypnotic agent in any clinical setting. Methods We searched eligible studies in PubMed, Google Scholar, and the Cochrane Register of Clinical Trials. The following inclusion criteria were used: random treatment allocation and comparison between propofol and any comparator in any clinical setting. The primary outcome was mortality at the longest follow-up available. We conducted a fixed-effects meta-analysis for the risk ratio (RR). Using this RR and 95% confidence interval, we estimated the probability of any harm (RR > 1) through Bayesian statistics. We registered this systematic review and meta-analysis in PROSPERO International Prospective Register of Systematic Reviews (CRD42022323143). Results We identified 252 randomized trials comprising 30,757 patients. Mortality was higher in the propofol group than in the comparator group (760/14,754 [5.2%] vs. 682/16,003 [4.3%]; RR = 1.10; 95% confidence interval, 1.01–1.20; p = 0.03; I2 = 0%; number needed to harm = 235), corresponding to a 98.4% probability of any increase in mortality. A statistically significant mortality increase in the propofol group was confirmed in subgroups of cardiac surgery, adult patients, volatile agent as comparator, large studies, and studies with low mortality in the comparator arm. Conclusions Propofol may reduce survival in perioperative and critically ill patients. This needs careful assessment of the risk versus benefit of propofol compared to other agents while planning for large, pragmatic multicentric randomized controlled trials to provide a definitive answer. Graphical Abstract

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Continuous propofol perfusion in critically ill children

Cited by 2 publications

References 24 publications

Propofol for Pediatric Colonoscopy

Propofol for Pediatric Colonoscopy

Propofol and survival: an updated meta-analysis of randomized clinical trials

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