OBJECTIVES:

The use of propofol in general anesthesia in children less than 3 years of age remain off-label in many countries because its safety and effectiveness have not been established. We performed a systematic review to evaluate propofol anesthesia in young children.

METHODS:

A comprehensive literature search was conducted in three databases to find all randomized clinical trials of propofol versus any other agents for general anesthesia conducted with children under 3 years old.

RESULTS:

A total of 14 papers from 12 unique randomized controlled trials were included. Induction of anesthesia with propofol was compared to thiopentone, sevoflurane, and halothane in eight articles and maintenance of anesthesia with propofol was compared to sevoflurane and dexmedetomidine in four articles. Two studies compared propofol to dexmedetomidine for both induction and maintenance.

Achievement of adequate intubation condition was significantly lower in the propofol treated group (RR 0.62, 95% CI 0.48 ~ 0.81). Regarding hemodynamic responses after the induction, treatment effects differed by control. The propofol group showed higher mean blood pressures compared to sevoflurane, but yielded lower blood pressures than thiopentone and dexmedetomidine. It also demonstrated higher heart rates than the dexmedetomidine, while showing lower heart rates than thiopentone and sevoflurane. In overall, there were tendencies to lower minimum mean arterial pressures and heart rates after the induction in propofol group than controls(MBPs: -3.00, 95% CI -7.84 ~ 1.85; HRs: -6.91, 95% CI -17.21 ~ 3.39). Adverse events including desaturation, apnoea, postoperative nausea and vomiting, and emergence agitation, did not differ significantly. Recovery times including time to extubation, eye opening, and emergence also did not differ significantly.

CONCLUSIONS:

A meta-analysis showed that propofol did not significantly lower hemodynamic responses than other general anesthetic agents. Profiles of adverse events and times to recovery of propofol group were not significantly different from those of the controls.