Propofol syndrome in children

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.