OBJECTIVES: We aimed to assess the safety and efficacy of propofol as an agent of procedural sedation for pediatric patients.

METHODS: We searched the MEDLINE via Ovid, EMBASE, and Cochrane Central Register of Controlled Trials in June, 2016. Eligible studies were randomized controlled trials comparing propofol with other sedative agents for procedural sedation in pediatric patients. We used standard Cochrane methodological procedures, including assessment of risk of bias. Random effects model was used. The relative risk (RR) and risk difference (RD) with 95% confidence interval (CI) were calculated for dichotomous outcomes. The weighted and standardized mean difference (WMD and SMD) with 95% CI were used for continuous outcomes.

RESULTS: Of the 3,424 articles identified, 42 studies were included. While significant heterogeneity between studies was observed no overall significant difference in sedation adequacy was found between propofol and control groups. Physician satisfaction was significantly higher in the propofol groups (RR = 1.21; P < 0.05). The propofol use was also associated with some significant benefits in recovery time (WMD = -7.59; P < 0.05) and in reducing emergency agitation, Pediatric Anesthesia Emergence Delirium (PAED) scale scores and nausea/vomiting (RD = -0.10; WMD = -3.60; RD = -0.05 respectively, with P < 0.05 for all outcomes). Although some hemodynamic responses and respiratory rate were lower in the propofol groups, there were no statistically significant differences between groups in terms of heart rate, end-tidal Co, cardiovascular problems and respiratory complications.

CONCLUSIONS: Propofol provided adequate sedation for uncomfortable procedures with a shorter recovery time than other sedative agents. While with some concerns about reducing hemodynamic responses, propofol had a similar or better safety profile comparing with other sedatives. The overall evidence suggests that propofol could be considered for pediatric procedure sedation.