{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:34:20Z","timestamp":1786365260529,"version":"build-2736575974"},"reference-count":40,"publisher":"The Pediatric Pharmacy Association","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8]]},"abstract":"\n OBJECTIVES<\/jats:title>\n Propofol is used sparingly in pediatrics owing to the risk of propofol-related infusion syndrome (PRIS). The objective of this study is to evaluate the safety of propofol in pediatrics and describe its effectiveness at facilitating extubation and decreasing concomitant sedation.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n This retrospective, descriptive study evaluated critically ill children who received continuous propofol infusions for at least 12 consecutive hours while admitted to pediatric, congenital cardiac, or neonatal intensive care units. The primary outcome was PRIS incidence. Secondary outcomes included change from baseline in laboratory parameters, discontinuation due to adverse effects, change in sedative requirements following sedation washout, and successful extubation.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n From January 1, 2019, to November 1, 2023, a total of 100 children received 120 courses of propofol infusions. The median infusion rate was 106 mcg\/kg\/min (IQR, 68\u2013149) and 27.5% of courses exceeded 48 hours in duration. No PRIS events were identified. Patients experienced a moderate, non\u2013duration-dependent increase in triglycerides, with no impact on aspartate aminotransferase (AST)\/alanine aminotransferase (ALT) concentrations; 11.7% of infusions were discontinued for adverse effects. No children self-extubated while on propofol when used for peri-extubation (N = 49). Opioid and benzodiazepine requirements were decreased by 17% and 26% from baseline, respectively, during a 24-hour period following sedation washout (N = 26).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Propofol was tolerated by most patients at doses commonly exceeding guideline-recommended maximum rate and duration. Propofol was safely used to facilitate extubation and decreased baseline sedative exposure when used for sedation washout in a complex critically ill pediatric population.<\/jats:p>\n <\/jats:sec>","DOI":"10.5863\/jppt-25-00063","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:26:24Z","timestamp":1786364784000},"page":"540-548","source":"Crossref","is-referenced-by-count":0,"title":["Characterizing the Safety and Efficacy of Propofol in Critically Ill Pediatric Patients"],"prefix":"10.5863","volume":"31","author":[{"given":"Benjamin","family":"Colwell","sequence":"first","affiliation":[{"name":"Department of Pharmacy (BC, FB, MS, JT, AAS), NYU Langone Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferras","family":"Bashqoy","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (BC, FB, MS, JT, AAS), NYU Langone Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Spilios","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (BC, FB, MS, JT, AAS), NYU Langone Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Tracy","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (BC, FB, MS, JT, AAS), NYU Langone Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ami J.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (AJS), NYU Langone Medical Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anasemon A.","family":"Saad","sequence":"additional","affiliation":[{"name":"Department of Pharmacy (BC, FB, MS, JT, AAS), NYU Langone Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3883","reference":[{"key":"JPPT-25-00063-b01","year":"2022","unstructured":"Propofol [package insert]. Lake Zurich, IL: Fresenius Kabi USA, LLC; 2022."},{"issue":"2","key":"JPPT-25-00063-b02","series-title":"CNS Neurosci Ther","first-page":"95","article-title":"The experimental and clinical pharmacology of propofol, an anesthetic agent with neuroprotective properties","volume":"14","author":"Kotani","year":"2008","unstructured":"Kotani Y, Shimazawa M, Yoshimura S, et al. The experimental and clinical pharmacology of propofol, an anesthetic agent with neuroprotective properties. CNS Neurosci Ther. 2008;14(2):95\u2212106."},{"issue":"4","key":"JPPT-25-00063-b03","series-title":"CHEST Crit Care","first-page":"100099","article-title":"Time is brain: a narrative review of pediatric status epilepticus","volume":"2","author":"Benedetti","year":"2024","unstructured":"Benedetti G, Morgan L, Harrar D. Time is brain: a narrative review of pediatric status epilepticus. CHEST Crit Care. 2024;2(4):100099."},{"issue":"7","key":"JPPT-25-00063-b04","series-title":"Anaesthesia","first-page":"690","article-title":"Propofol infusion syndrome","volume":"62","author":"Kam","year":"2007","unstructured":"Kam P, Cardone P. Propofol infusion syndrome. Anaesthesia. 2007;62(7):690\u2212701."},{"issue":"3","key":"JPPT-25-00063-b05","series-title":"J Pediatr Pharmacol Ther","first-page":"263","article-title":"Adherence to a pediatric continuous infusion propofol policy for sedation in mechanically ventilated patients: opportunities for change and improvement","volume":"27","author":"Martin","year":"2022","unstructured":"Martin A, Tribuzi A, Schieber M, et al. Adherence to a pediatric continuous infusion propofol policy for sedation in mechanically ventilated patients: opportunities for change and improvement. J Pediatr Pharmacol Ther. 2022;27(3):263\u2212269."},{"issue":"4","key":"JPPT-25-00063-b06","series-title":"Nurs Crit Care","first-page":"198","article-title":"The use of propofol sedation in a paediatric intensive care unit","volume":"17","author":"Svensson","year":"2012","unstructured":"Svensson ML, Lindberg L. The use of propofol sedation in a paediatric intensive care unit. Nurs Crit Care. 2012;17(4):198\u2212203."},{"issue":"255","key":"JPPT-25-00063-b07","series-title":"Front Pediatr","first-page":"1","article-title":"Propofol infusion is a feasible bridge to extubation in general pediatric intensive care unit","volume":"8","author":"Bhalala","year":"2020","unstructured":"Bhalala U, Patel A, Thangavelu M, et al. Propofol infusion is a feasible bridge to extubation in general pediatric intensive care unit. Front Pediatr. 2020:8(255):1\u22126."},{"issue":"8","key":"JPPT-25-00063-b08","series-title":"Cureus","first-page":"e27925","article-title":"Propofol in the pediatric intensive care unit, a safe and effective agent in reducing pain and sedation infusions: a single-center retrospective study","volume":"14","author":"Uppuluri","year":"2022","unstructured":"Uppuluri S, Villarreal EG, Dorsey V, et al. Propofol in the pediatric intensive care unit, a safe and effective agent in reducing pain and sedation infusions: a single-center retrospective study. Cureus. 2022;14(8):e27925."},{"issue":"6854","key":"JPPT-25-00063-b09","series-title":"BMJ","first-page":"613","article-title":"Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports","volume":"305","author":"Parke","year":"1992","unstructured":"Parke TJ, Stevens JE, Rice AS, et al. Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. BMJ. 1992;305(6854):613\u2212616."},{"issue":"6","key":"JPPT-25-00063-b10","series-title":"Pediatr Anesth","first-page":"491","article-title":"Propofol infusion syndrome in children","volume":"8","author":"Bray","year":"1998","unstructured":"Bray RJ. Propofol infusion syndrome in children. Pediatr Anesth. 1998;8(6):491\u2212499."},{"issue":"6859","key":"JPPT-25-00063-b11","series-title":"BMJ","first-page":"953","article-title":"Propofol infusion in children","volume":"305","author":"Barclay","year":"1992","unstructured":"Barclay K, Williams AJ, Major E. Propofol infusion in children. BMJ. 1992;305(6859):953."},{"issue":"2","key":"JPPT-25-00063-b12","series-title":"Crit Care Med","first-page":"405","article-title":"Fatal metabolic acidosis in a pediatric patient receiving an infusion of propofol in the intensive care unit: is there a relationship?","volume":"23","author":"Strickland","year":"1995","unstructured":"Strickland RA, Murray MJ. Fatal metabolic acidosis in a pediatric patient receiving an infusion of propofol in the intensive care unit: is there a relationship? Crit Care Med. 1995;23(2):405\u2013409."},{"issue":"8","key":"JPPT-25-00063-b13","series-title":"Crit Care Med","first-page":"2281","article-title":"Predictors of mortality in patients with suspected propofol infusion syndrome","volume":"36","author":"Fong","year":"2008","unstructured":"Fong JJ, Sylvia L, Ruthazer R, et al. Predictors of mortality in patients with suspected propofol infusion syndrome. Crit Care Med. 2008;36(8):2281\u22122287."},{"key":"JPPT-25-00063-b14","article-title":"safety alerts for drugs, biologics, medical devices, and dietary supplements","year":"2001","unstructured":"US Food and Drug Administration MedWatch. 2001 safety alerts for drugs, biologics, medical devices, and dietary supplements. Diprivan (propofol). Accessed December 23, 2023. http:\/\/www.fda.gov\/medwaTCH\/SAFETY\/2001\/safety01.htm#diprivan%5D"},{"issue":"4","key":"JPPT-25-00063-b15","series-title":"J Pediatr Pharmacol Ther","first-page":"422","article-title":"Pediatric Pharmacy Association 2025 KIDs List of Key Potentially Inappropriate Drugs in Pediatrics","volume":"30","author":"McPherson","year":"2025","unstructured":"McPherson C, Meyers R, Thackray J, et al. Pediatric Pharmacy Association 2025 KIDs List of Key Potentially Inappropriate Drugs in Pediatrics. J Pediatr Pharmacol Ther. 2025;30(4):422\u2013439."},{"key":"JPPT-25-00063-b16","series-title":"Ped Crit Care Med","first-page":"e74","article-title":"2022 Society of Critical Care Medicine clinical practice guidelines for prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility","volume":"23","author":"Smith","year":"2022","unstructured":"Smith H, Besunder J, Betters K, et al.2022 Society of Critical Care Medicine clinical practice guidelines for prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility. Ped Crit Care Med. 2022;23:e74\u2013e110."},{"key":"JPPT-25-00063-b17","series-title":"Pediatrics","first-page":"1177","article-title":"Continuous propofol infusion in 142 critically ill children","volume":"110","author":"Cornfield","year":"2002","unstructured":"Cornfield DN, Tegtmeyer K, Nelson MD, et al. Continuous propofol infusion in 142 critically ill children. Pediatrics. 2002;110:1177\u20131181."},{"issue":"2","key":"JPPT-25-00063-b18","series-title":"Paediatr Anaesth","first-page":"143","article-title":"A comparison of propofol and other sedative use in paediatric intensive care in the United Kingdom","volume":"7","author":"Pepperman","year":"1997","unstructured":"Pepperman ML, Macrae D. A comparison of propofol and other sedative use in paediatric intensive care in the United Kingdom. Paediatr Anaesth. 1997;7(2):143\u2212153."},{"issue":"8","key":"JPPT-25-00063-b19","series-title":"J Pediatr Pharmacol Ther","first-page":"714","article-title":"Characterization of propofol use for non-procedral sedation in a pediatric intensive care unit","volume":"28","author":"Bartlett","year":"2023","unstructured":"Bartlett JW, Curry BN, Musick, MA, et al. Characterization of propofol use for non-procedral sedation in a pediatric intensive care unit. J Pediatr Pharmacol Ther. 2023;28(8):714\u2212720."},{"issue":"1","key":"JPPT-25-00063-b20","series-title":"J Pediatr Pharmacol Ther","first-page":"17","article-title":"Propofol-related infusion syndrome in critically ill pediatric patients: coincidence, association, or causation?","volume":"11","author":"Timpe","year":"2006","unstructured":"Timpe E, Eichner S, Phelps S. Propofol-related infusion syndrome in critically ill pediatric patients: coincidence, association, or causation? J Pediatr Pharmacol Ther. 2006;11(1):17\u221242."},{"issue":"9","key":"JPPT-25-00063-b21","series-title":"Intensive Care Med","first-page":"1417","article-title":"The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome","volume":"29","author":"Vasile","year":"2003","unstructured":"Vasile B, Rasulo F, Candiani A, et al. The pathophysiology of propofol infusion syndrome: a simple name for a complex syndrome. Intensive Care Med. 2003;29(9):1417\u22121425."},{"key":"JPPT-25-00063-b22","series-title":"Crit Care","first-page":"398","article-title":"Propofol infusion syndrome: a structured review of experimental studies and 153 published case reports","volume":"19","author":"Krajcova","year":"2015","unstructured":"Krajcova A, Waldauf P, Andel M, et al. Propofol infusion syndrome: a structured review of experimental studies and 153 published case reports. Crit Care. 2015;19:398."},{"issue":"4","key":"JPPT-25-00063-b23","series-title":"Br J Anaesth","first-page":"448","article-title":"Propofol infusion syndrome: a structured literature review and analysis of published case reports","volume":"122","author":"Hemphill","year":"2019","unstructured":"Hemphill S, McMenamin L, Bellamy M, et al. Propofol infusion syndrome: a structured literature review and analysis of published case reports. Br J Anaesth. 2019;122(4):448\u2212459."},{"issue":"1","key":"JPPT-25-00063-b24","series-title":"Cardiol Young","first-page":"46","article-title":"Propofol as a bridge to extubation for high-risk children with congenital cardiac disease","volume":"21","author":"Teng","year":"2011","unstructured":"Teng S, Kaufman J, Czaja A, et al. Propofol as a bridge to extubation for high-risk children with congenital cardiac disease. Cardiol Young. 2011;21(1):46\u221251."},{"issue":"4","key":"JPPT-25-00063-b25","series-title":"J Pediatr Pharmacol Ther","first-page":"354","article-title":"Propofol sedation washouts in critically ill infants: a case series","volume":"28","author":"Deptola","year":"2023","unstructured":"Deptola S, Hemmann B, Hemmelgarn T, et al. Propofol sedation washouts in critically ill infants: a case series. J Pediatr Pharmacol Ther. 2023;28(4):354\u2212364."},{"issue":"11","key":"JPPT-25-00063-b26","series-title":"Am Fam Physician","first-page":"709","article-title":"Mildly elevated liver transaminase levels: causes and evaluation","volume":"96","author":"Oh","year":"2017","unstructured":"Oh R, Hustead T, Ali S, et al. Mildly elevated liver transaminase levels: causes and evaluation. Am Fam Physician. 2017;96(11):709\u2212715."},{"issue":"6","key":"JPPT-25-00063-b27","series-title":"Nutr Clin Pract","first-page":"1106","article-title":"ASPEN lipid injectable emulsion safety recommendations part 2: neonate and pediatric recommendations","volume":"36","author":"Cober","year":"2021","unstructured":"Cober M, Gura K, Mirtallo J, et al. ASPEN lipid injectable emulsion safety recommendations part 2: neonate and pediatric recommendations. Nutr Clin Pract. 2021;36(6):1106\u20131125."},{"issue":"5","key":"JPPT-25-00063-b28","series-title":"Nutr Clin Pract","first-page":"769","article-title":"ASPEN lipid injectable emulsion safety recommendations, part 1: background and adult considerations","volume":"35","author":"Mirtallo","year":"2020","unstructured":"Mirtallo J, Ayers P, Boullata J, et al. ASPEN lipid injectable emulsion safety recommendations, part 1: background and adult considerations. Nutr Clin Pract. 2020;35(5):769\u2212782."},{"issue":"4","key":"JPPT-25-00063-b29","series-title":"J Neurol","first-page":"877","article-title":"A systematic review on the definition of rhabdomyolysis","volume":"267","author":"Stahl","year":"2020","unstructured":"Stahl K, Rastelli E, Schoser B. A systematic review on the definition of rhabdomyolysis. J Neurol. 2020;267(4):877\u2013882."},{"issue":"1","key":"JPPT-25-00063-b30","series-title":"Kidney Int Suppl","first-page":"19","article-title":"KDIGO clinical practice guideline for acute kidney injury: AKI definition","volume":"2","year":"2012","unstructured":"KDIGO clinical practice guideline for acute kidney injury: AKI definition. Kidney Int Suppl. 2012;2(1):19\u201336."},{"issue":"suppl 1","key":"JPPT-25-00063-b31","series-title":"Pediatrics","first-page":"e2020038505D","article-title":"Part 4: Pediatric Basic and Advanced Life Support 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care","volume":"147","author":"Topjian","year":"2021","unstructured":"Topjian A, Raymond T, Atkins D, et al. Part 4: Pediatric Basic and Advanced Life Support 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics. 2021;147(suppl 1):e2020038505D."},{"issue":"2","key":"JPPT-25-00063-b32","series-title":"Anesthesiology","first-page":"286","article-title":"A double-blind, randomized comparison of i.v. lorazepam to midazolam for sedation of ICU patients via a pharmacologic model","volume":"95","author":"Barr","year":"2001","unstructured":"Barr J, Zomorodi K, Bertaccini EJ, et al. A double-blind, randomized comparison of i.v. lorazepam to midazolam for sedation of ICU patients via a pharmacologic model. Anesthesiology. 2001;95(2):286\u2212298."},{"key":"JPPT-25-00063-b33","series-title":"Demystifying Opioid Conversion Calculations: a Guide for Effective Dosing","author":"McPherson","year":"2018","unstructured":"McPherson ML. Demystifying Opioid Conversion Calculations: a Guide for Effective Dosing. 2nd ed. American Society of Health-System Pharmacists; 2018."},{"issue":"1","key":"JPPT-25-00063-b34","series-title":"Crit Care Med","first-page":"436","article-title":"880: L-Carnitine for propofol-induced hypertriglyceridemia: a case series","volume":"50","author":"Brouse","year":"2022","unstructured":"Brouse T, Ryman K, Kataria V. 880: L-Carnitine for propofol-induced hypertriglyceridemia: a case series. Crit Care Med. 2022;50(1):436."},{"issue":"5","key":"JPPT-25-00063-b35","series-title":"Open J Anesthesiol","first-page":"147","article-title":"Effects of L-Carnitine on propofol-induced inhibition of free fatty acid metabolism in fasted rats and in vitro","volume":"8","author":"Moriyama","year":"2018","unstructured":"Moriyama T, Kiyonaga N, Ushikai M, et al. Effects of L-Carnitine on propofol-induced inhibition of free fatty acid metabolism in fasted rats and in vitro. Open J Anesthesiol. 2018;8(5):147\u2013158."},{"issue":"2","key":"JPPT-25-00063-b36","series-title":"Br J Pharmacol","first-page":"384","article-title":"Cellular neuroadaptations to chronic opioids: tolerance withdrawal, and addiction","volume":"154","author":"Christie","year":"2008","unstructured":"Christie MJ. Cellular neuroadaptations to chronic opioids: tolerance withdrawal, and addiction. Br J Pharmacol. 2008;154(2);384\u2212396."},{"issue":"1","key":"JPPT-25-00063-b37","series-title":"Pharmacol Rev","first-page":"223","article-title":"Regulation of mu-opioid receptors: desensitization, phosphorylation, internalization, and tolerance","volume":"65","author":"Williams","year":"2013","unstructured":"Williams J, Ingram S, Henderson G, et al. Regulation of mu-opioid receptors: desensitization, phosphorylation, internalization, and tolerance. Pharmacol Rev. 2013;65(1):223\u2212254."},{"issue":"6","key":"JPPT-25-00063-b38","series-title":"Mol Med Rep","first-page":"1333","article-title":"Propofol increases mu-opioid receptor expression in SH-SY5Y human neuroblastoma cells","volume":"6","author":"Zuojun","year":"2012","unstructured":"Zuojun L, Pei Q, Linyong X, et al. Propofol increases mu-opioid receptor expression in SH-SY5Y human neuroblastoma cells. Mol Med Rep. 2012;6(6):1333\u22121336."},{"issue":"8","key":"JPPT-25-00063-b39","series-title":"Pharmazie","first-page":"677","article-title":"Propofol up-regulates Mas receptor expression in dorsal root ganglion neurons","volume":"68","author":"Lijun","year":"2013","unstructured":"Lijun C, Xun J, Jiang X, et al. Propofol up-regulates Mas receptor expression in dorsal root ganglion neurons. Pharmazie. 2013;68(8):677\u2212680."},{"issue":"6","key":"JPPT-25-00063-b40","series-title":"J Burn Care Rehabil","first-page":"356","article-title":"Short-term propofol infusion as an adjunct to extubation in burned children","volume":"24","author":"Sheridan","year":"2003","unstructured":"Sheridan RL, Keaney T, Stoddard F, et al. Short-term propofol infusion as an adjunct to extubation in burned children. J Burn Care Rehabil. 2003;24(6):356\u2212360."}],"container-title":["The Journal of Pediatric Pharmacology and Therapeutics"],"original-title":[],"link":[{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/31\/4\/article-p540.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/31\/4\/article-p540.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/jppt.kglmeridian.com\/downloadpdf\/journals\/jppt\/31\/4\/article-p540.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T12:26:24Z","timestamp":1786364784000},"score":1,"resource":{"primary":{"URL":"https:\/\/jppt.kglmeridian.com\/view\/journals\/jppt\/31\/4\/article-p540.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":40,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.5863\/jppt-25-00063","relation":{},"ISSN":["2331-348X","1551-6776"],"issn-type":[{"value":"2331-348X","type":"electronic"},{"value":"1551-6776","type":"print"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}