Eric Wooltorton's1 statement that critically ill children, especially those with acute infections, should not be sedated with propofol in the intensive care unit is a well-known fact. This is the sole thrust of the March 2001 alert from the US Food and Drug Administration on this subject.2
Propofol is used safely in children around the world, so it is a considerable stretch to now suggest that the “[propofol] syndrome may be less common when the drug is used in less critically ill pediatric patients for short periods (e.g., for procedural sedation or for the induction and maintenance of general anesthesia).”1 In this context, what does “may be less common” mean? Almost never or never? Is this a “theoretical risk” to be explained to parents?
Except for 2 cases reported by Finley and colleagues,3 propofol has proven remarkably safe for anesthesia in children from the age of 3 weeks. For short procedures such as MRI, children with mitochondrial myopathies may be more safely anesthetized with propofol than with halogenated agents, barbiturates or nitrous oxide.4
I.A. Jeremy Sloan Senior Staff Anesthesiologist 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. [PMC free article] [PubMed]
- 2.Diprivan (propofol). In: Medwatch: The FDA Safety Information and Adverse Event Reporting Program. 2001 safety information summaries. Washington: US Food and Drug Administration; 2001 Apr 25. Available: www.fda.gov/medwatch/safety/2001/safety01.htm#dipriv (accessed 2003 Feb 13).
- 3.Finley GA, MacManus B, Sampson SE, Fernandez CV, Retallick R. Delayed seizures following sedation with propofol. Can J Anaesth 1993;40 (9): 863-5. [DOI] [PubMed]
- 4.Cohen BH, Shoffner J, DeBoer G. Anesthesia and mitochondrial cytopathies. Monroeville (PA): United Mitochondrial Disease Foundation; 1998. Available: www.umdf.org/ (accessed 2003 Feb 18).