Propofol

Indications

Propofol is used for: General anaesthesia, Sedation

Adult Dose

Intravenous Induction and maintenance of general anaesthesia Adult: Induction: 40 mg by inj or infusion every 10 sec. Usual dose: 1.5-2.5 mg/kg. Maintenance: 4-12 mg/kg/hr or intermittent bolus inj of 20-50 mg. Elderly: Including neurosurgical and debilitated patients: Infuse at a rate of 20 mg every 10 sec. Maintenance: 3-6 mg/kg/hr. Usual dose needed: 1-1.5 mg/kg. Sedation Adult: In diagnostic and surgical procedures: Initially, 6-9 mg/kg/hr by infusion given for 3-5 minutes or an alternative dose of 0.5-1 mg/kg by slow inj over 1-5 minutes. Maintenance: 1.5-4.5 mg/kg/hr infusion. Reduce maintenance dose by 20% for high-risk patients needing sedation. For ventilated patients: 0.3-4 mg/kg/hr by infusion. Monitor lipid concentrations if duration of sedation lasts >3 days.

Child Dose

Intravenous Anesthesia Induction 3-16 years: 2.5-3.5 mg/kg IVP over 20-30 sec Maintenance 2 months to 16 years: 0.125-0.3 mg/kg/min IV

Renal Dose

Administration

Contra Indications

Electroconvulsive therapy, obstetrics. Sedation in children <16 yr. Pregnancy, lactation.

Precautions

Paediatrics, elderly, hypovolaemia, epilepsy, lipid disorders, patients with increased intracranial pressure. Avoid rapid bolus doses in high risk patients. Emulsion formulation of propofol 2% should only be used in children >3 yr. Lactation: Excreted in breast milk; effect on nursing infant not known

Pregnancy-Lactation

Interactions

Reduce dose if given with nitrous oxide or halogenated anaesthetics. Increased sedative, anaesthetic and cardiorespiratory effects when used with other CNS depressants.

Adverse Effects

Side effects of Propofol : >10% Hypotension (peds 17%; adults 3-26%),Apnea lasting 30-60 sec (peds 10%; adults 24%),Apnea lasting >60 sec (peds 5%; adults 12%),Movement (peds 17%; adults 3-10%),Injection site burning/stinging/pain (peds 10%; adults 18%) 1-10% Respiratory acidosis during weaning (3-10%),Hypertriglyceridemia (3-10%),Hypertension (peds 8%),Rash (peds 5%; adults 1-3%),Pruritus (1-3%),Arrhythmia (1-3%),Bradycardia (1-3%),Cardiac output decreased (1-3%; concurrent opioid use increases incidence).Tachycardia (1-3%) <1% Arterial hypotension,Anaphylaxis,Asystole,Bronchospasm,Cardiac arrest,Seizures,Opisthotic rxn,Pancreatitis,Pulmonary edema,Phlebitis,Thrombosis,Renal tubular toxicity Potentially Fatal: Apnoea, bradycardia, hypotension, convulsions; anaphylaxis.

Mechanism of Action

Short-acting, lipophilic sedative/hypnotic; causes global CNS depression, presumably through agonist actions on GABAa receptors.