Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports.
OBJECTIVE
To examine the possible contribution of sedation with propofol in the deaths of children who were intubated and required intensive care.


METHODS
Case note review.


METHODS
Three intensive care units.


METHODS
Five children with upper respiratory tract infections aged between 4 weeks and 6 years.


RESULTS
Four patients had laryngotracheo-bronchitis and one had bronchiolitis. All were sedated with propofol. The clinical course in all five cases was remarkably similar: an increasing metabolic acidosis was associated with brady-arrhythmia and progressive myocardial failure, which did not respond to resuscitative measures. All children developed lipaemic serum after starting propofol. These features are not usually associated with respiratory tract infections. No evidence was found of viral myocarditis, which was considered as a possible cause of death.


CONCLUSIONS
Although the exact cause of death in these children could not be defined, propofol may have been a contributing factor.
Parke
T J
TJ
Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford.
Stevens
J E
JE
Rice
A S
AS
Greenaway
C L
CL
Bray
R J
RJ
Smith
P J
PJ
Waldmann
C S
CS
Verghese
C
C
D000138:Acidosis / Q000139:chemically induced*; D000208:Acute Disease; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005260:Female; D006333:Heart Failure / Q000139:chemically induced*; D006801:Humans; D008297:Male; D015742:Propofol / Q000009:adverse effects*; D012141:Respiratory Tract Infections / Q000628:therapy
D015742:Propofol