Review article: Safety profile of propofol for paediatric procedural sedation in the emergency department.

The use of propofol for paediatric procedural sedation (PPS) is increasing because of its favourable pharmacodynamic profile. Its paediatric use has been limited in some ED (emergency departments) because of the perceived high rate of serious adverse events in comparison with other sedation agents. A systematic literature review of propofol use for PPS outside the operating theatre environment from 1966 to 2008 was carried out to profile the adverse event rate in comparison with other procedural sedation agents. Sixty studies with a total of 17,066 paediatric propofol sedations in a variety of hospital settings were identified. The incidence of complications were: desaturation 9.3%, apnoea 1.9%, assisted ventilation 1.4%, hypotension 15.4%, unplanned intubation 0.02%, emesis post procedure 0.14%, laryngospasm 0.1% and bradycardia 0.1%. There were no reported incidents of aspiration or emesis during sedation and there were no deaths associated with procedural propofol sedation. The use of propofol for PPS is associated with a low rate of minor adverse events that are all reversible with minimal intervention and do not produce long-term sequelae and occur at similar rates to minor adverse events experienced with other sedation agents. Major adverse events with propofol sedation are extremely rare and appropriate patient and procedure selection would decrease these risks further. The increasing use of propofol for ED PPS is supported by the current evidence because of its comparable adverse event rate to other agents.