Propofol

# Propofol ## Overview - **Classification**: Short-acting intravenous general anesthetic and sedative-hypnotic agent. - **Mechanism**: Modulates GABA-A receptors, enhancing inhibitory neurotransmission and causing dose-dependent CNS depression. ## Primary Indications 1. **Induction and Maintenance of General Anesthesia**: For surgical or diagnostic procedures. 2. **Sedation for Mechanically Ventilated Patients**: In the Intensive Care Unit (ICU) setting. 3. **Sedation for Diagnostic Procedures**: E.g., endoscopy, MRI. ## Adult Dosing ### Standard Dosing **Induction of General Anesthesia** - **Dose**: **1.5-2.5 mg/kg** IV - **Frequency**: Single bolus over 20-40 seconds - **Route**: Intravenous (IV) - **Special Considerations**: Lower doses for elderly or debilitated patients. **Maintenance of General Anesthesia** - **Dose**: **100-200 mcg/kg/min** (**6-12 mg/kg/hr**) - **Frequency**: Continuous infusion, titrated to effect - **Route**: Intravenous (IV) **ICU Sedation** - **Dose**: **5-50 mcg/kg/min** (**0.3-3 mg/kg/hr**) - **Frequency**: Continuous infusion, titrated to effect - **Route**: Intravenous (IV) - **Maximum Dose**: Avoid exceeding **50 mcg/kg/min** for prolonged periods due to PRIS risk. ### Dose Adjustments - **Renal Impairment**: No specific dose adjustment recommended. Metabolites are renally excreted. - **Hepatic Impairment**: No specific dose adjustment recommended, but use with caution. Hepatic metabolism is extensive. - **Elderly Patients**: Require **reduced doses** (e.g., **1-1.5 mg/kg** for induction) due to increased sensitivity and reduced clearance. Titrate slowly. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: Not routinely recommended due to limited data and increased PRIS risk. - **Special Notes**: Use for induction of anesthesia only in specific circumstances. Closely monitor for hemodynamic instability. ### Infants (1-12 months) - **Dose**: Not recommended for prolonged sedation in ICU due to high PRIS risk. * **Induction (≥1 month)**: **2.5-3.5 mg/kg** IV over 20-30 seconds. - **Maximum**: Refer to pediatric anesthesia guidelines for specific procedural use. ### Children (1-12 years) - **Dose**: Not recommended for prolonged sedation in ICU due to high PRIS risk. * **Induction (≥3 years)**: **2.5-3.5 mg/kg** IV over 20-30 seconds. * **Maintenance (≥3 years)**: **125-300 mcg/kg/min** (**7.5-18 mg/kg/hr**) continuous IV infusion. - **Maximum**: Generally, up to **18 mg/kg/hr** for maintenance. ### Adolescents (13-18 years) - **Dose**: Approach adult dosing, starting at lower end of range. * **Induction**: **1.5-2.5 mg/kg** IV. * **Maintenance**: **100-200 mcg/kg/min**. - **Maximum**: Adult maximums apply, but still monitor closely for PRIS with prolonged infusions. ## Safety Information ### Contraindications - **Absolute**: Known hypersensitivity to propofol or any component (egg, soy). - **Absolute**: Patients receiving parenteral nutrition with fat emulsions (soybean oil). - **Absolute**: For obstetric sedation or general anesthesia (crosses placenta). - **Absolute**: For prolonged sedation in children <16 years (ICU setting) due to PRIS risk. ### Common Adverse Effects - **Very Common (>10%)**: Hypotension, Injection site pain, Apnea. - **Common (1-10%)**: Bradycardia, Nausea/Vomiting, Headache. - **Serious but Rare**: Propofol Infusion Syndrome (PRIS), Anaphylaxis, Seizures (during recovery), Rhabdomyolysis. ### Key Drug Interactions - **Opioids/Sedatives (e.g., Fentanyl, Midazolam)**: Potentiate sedative and respiratory depressant effects. **Reduced propofol dose** may be needed. - **Neuromuscular Blockers**: No direct interaction; dose of NMB may need adjusting if onset of action is prolonged by propofol's hemodynamic effects. - **Volatile Anesthetics**: May have additive myocardial depressant effects. **Careful titration** of both agents. ## Monitoring & Follow-up - **Before Treatment**: Baseline vital signs (BP, HR, RR, SpO2), ECG, neurological status. - **During Treatment**: Continuous monitoring of vital signs, SpO2, ECG. Monitor level of consciousness. * **For prolonged infusions (ICU)**: Monitor triglycerides (baseline, then every 3 days), creatine kinase (CK), acid-base status, urine output for PRIS signs. - **Clinical Signs**: Watch for hypotension, bradycardia, respiratory depression, metabolic acidosis (PRIS), rhabdomyolysis (PRIS), cardiac failure (PRIS). ## Clinical Pearls - 💡 **Pain on injection**: Can be minimized by injecting into larger veins or co-administering lidocaine prior to propofol. - 💡 **Risk of PRIS**: Increases with prolonged infusions (>48 hrs), high doses (>4 mg/kg/hr or >67 mcg/kg/min), concurrent illness (sepsis, head injury), and in children. - 💡 **Aseptic Technique**: Propofol supports bacterial growth. Discard opened vials within 6-12 hours (check product-specific guidelines) to prevent infection. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.