Propofol: a review of its role in pediatric anesthesia and sedation
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TLDR
There is no direct evidence in humans for propofol-induced neurotoxicity to the infant brain; however, current concerns of neuroapoptosis in developing brains induced by prop ofol persist and continue to be a focus of research.Abstract:
Propofol is an intravenous agent used commonly for the induction and maintenance of anesthesia, procedural, and critical care sedation in children. The mechanisms of action on the central nervous system involve interactions at various neurotransmitter receptors, especially the gamma-aminobutyric acid A receptor. Approved for use in the USA by the Food and Drug Administration in 1989, its use for induction of anesthesia in children less than 3 years of age still remains off-label. Despite its wide use in pediatric anesthesia, there is conflicting literature about its safety and serious adverse effects in particular subsets of children. Particularly as children are not “little adults”, in this review, we emphasize
the maturational aspects of propofol pharmacokinetics. Despite the myriad of propofol pharmacokinetic-pharmacodynamic studies and the ability to use allometrical scaling to smooth out differences due to size and age, there is no optimal model that can be used in target controlled infusion pumps for providing closed loop total intravenous anesthesia in children. As the commercial formulation of propofol is a nutrient-rich emulsion, the risk for bacterial contamination exists despite the Food and Drug Administration mandating addition of antimicrobial preservative, calling for manufacturers’ directions to discard open vials after 6 h. While propofol has advantages over inhalation anesthesia such as less postoperative nausea and emergence delirium in children, pain on injection remains a problem even with newer formulations. Propofol is known to depress mitochondrial function by its action as an uncoupling agent in oxidative phosphorylation. This has implications for children with mitochondrial diseases and the occurrence of propofol-related infusion syndrome, a rare but seriously life-threatening complication of propofol. At the time of this review, there is no direct evidence in humans for propofol-induced neurotoxicity to the infant brain; however, current concerns of neuroapoptosis in developing brains induced by propofol persist and continue to be a focus of research.read more
Citations
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Journal ArticleDOI
Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease: A Scientific Statement From the American Heart Association.
Bradley S. Marino,Sarah Tabbutt,Graeme MacLaren,Mary Fran Hazinski,Ian Adatia,Dianne L. Atkins,Paul A. Checchia,Allan DeCaen,Ericka L. Fink,George M. Hoffman,John L. Jefferies,Monica E. Kleinman,Catherine D. Krawczeski,Daniel J. Licht,Duncan Macrae,Chitra Ravishankar,Ricardo A. Samson,Ravi R. Thiagarajan,Rune Toms,James S. Tweddell,Peter C. Laussen +20 more
TL;DR: The recommendations in this statement concur with the critical components of the 2015 American Heart Association pediatric basic life support and pediatric advanced life support guidelines and are meant to serve as a resuscitation supplement.
Journal ArticleDOI
Pain on injection of propofol: The effect of injectate temperature
A. McCrirrick,S. J. Hunter +1 more
TL;DR: The number of patients who experienced pain and the severity of the pain were reduced significantly when prop ofol was administered at a temperature of 4 degrees C and the efficacy of propofol as an induction agent appeared to remain unaltered.
Journal ArticleDOI
Pain on Injection of Propofol: The Effect of Injectate Temperature
A. McCrirrick,S. J. Hunter +1 more
TL;DR: In this article, a double-blind, randomised clinical study was undertaken to compare the effect of temperature on the incidence and severity of the pain experienced on injection of propofol.
Journal ArticleDOI
Recent Insights Into Molecular Mechanisms of Propofol-Induced Developmental Neurotoxicity: Implications for the Protective Strategies.
TL;DR: The evidence of neurotoxicity from animal models, animal cell culture, and human stem cell–derived neuron culture studies, and the mechanism of propofol-induced developmental neurotoxicity, such as increased cell death in neurons and oligodendrocytes, dysregulation of neurogenesis, abnormal dendritic development, and decreases in neurotrophic factor expression are presented.
Journal ArticleDOI
Subhypnotic doses of thiopentone and propofol cause analgesia to experimentally induced acute pain
E. Anker-Møller,N. Spangsberg,Lars Arendt-Nielsen,P. Schutz,Michael Kristensen,Peter Bjerring +5 more
TL;DR: It is concluded that, in subhypnotic doses, both thiopentone and propofol decrease the acute pain evoked by argon laser stimulation.
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