Authors: Moxham L, et al.
Pediatric Anesthesia, August 2025. doi:10.1111/pan.70031
This study evaluated propofol dosing requirements in children to better define safety margins between loss of eyelash reflex (LOER) and apnea. A total of 318 children, stratified by age and sex, were administered propofol until apnea occurred or a maximum dose of 10 mg/kg was reached.
The mean dose to LOER was 2.65 mg/kg, with no significant effect of sex or age. In contrast, the mean dose to apnea was 6.82 mg/kg, with males requiring higher doses and older children requiring lower doses. Importantly, older and female children demonstrated a narrower therapeutic index between sedation and apnea. In 62 participants, apnea was not reached even at the maximum dosing threshold.
These findings highlight significant variability in propofol response among pediatric patients, with sex and age influencing the margin of safety during induction.
Practical takeaway: Pediatric anesthesiologists should exercise heightened caution when using propofol in older and female children, as they exhibit narrower safety margins between sedation and apnea, making them more vulnerable to respiratory compromise.
Thank you to Pediatric Anesthesia for publishing this work.