We are analyzing https://link.springer.com/article/10.1007/s40263-015-0259-6.

Title:
Propofol: A Review of its Role in Pediatric Anesthesia and Sedation | CNS Drugs
Description:
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.
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Keywords {🔍}

google, scholar, pubmed, article, propofol, cas, children, anaesth, anesthesia, anesth, analg, anaesthesia, infusion, anesthesiology, pain, sedation, care, injection, doijx, paediatr, pharmacol, med, review, central, effect, pediatric, postoperative, clin, syndrome, intravenous, effects, pharmacokinetics, comparison, patients, doi, receptor, research, intensive, chidambaran, anesthetic, general, van, surgery, drug, administration, pharmacokinetic, anaesthesiol, concentrations, obese, sevoflurane,

Topics {✒️}

n-methyl-d-aspartate subtype month download article/chapter n-methyl-d-aspartate low-molecular-weight antioxidants remifentanil-induced postinfusion hyperalgesia medium/long chain triglycerides gamma-aminobutyric acid type gamma-aminobutyric acid-type gamma-aminobutyric acida receptors inhibitory amino-acid receptors spinal c-fos expression target-controlled infusion anesthesia propofol-induced eeg suppression preliminary structure-activity considerations propofol-related infusion syndrome full article pdf rodent central neurons accidental intra-arterial injection population pharmacokinetic-pharmacodynamic modeling day-surgery patients anesthetized individual effect-site concentrations discard open vials paediatric procedural sedation predicted effect-site concentration jones tk gamma-aminobutyric acid privacy choices/manage cookies closed-loop administration short-term propofol infusions target-controlled infusion target controlled infusion pediatr emergency care drug oxidation products rational opioid selection skilled motor tasks critical care sedation propofol pharmacokinetic-pharmacodynamic studies double-blind trial critical care med sole anaesthetic agent van limmen jg anesthesia-related morbidity de lange jj pediatr emerg care morbidly obese subjects congenital heart disease crit care clinics andrew costandi & ajay intensive care unit intravenous anesthetic agents

Questions {❓}

Are there still limitations for the use of target-controlled infusion in children?
Does the newer preparation of propofol, an emulsion of medium/long chain triglycerides cause less injection pain in children when premixed with lignocaine?
Is propofol a friend or a foe of the pediatric intensivist?
Mechanisms whereby propofol mediates peripheral vasodilation in humans: sympathoinhibition or direct vascular relaxation?

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