Propofol

A to Z Drug Facts

 Action Produces sedation/hypnosis rapidly (within 40 sec) and smoothly with minimal excitation; decreases intraocular pressure and systemic vascular resistance; rarely is associated with malignant hyperthermia and histamine release; suppresses cardiac output and respiratory drive.

 Indications Induction and maintenance of anesthesia in adults and children ³ 3 yr; initiation and maintenance of monitored anesthesia care sedation in adults; sedation in intubated or respiratory-controlled adult ICU patients.

 Contraindications Situations in which general anesthesia or sedation are contraindicated.

 Route/Dosage

Anesthesia

ADULTS < 55 YR: IV Induction: 40 mg q 10 sec until onset. Usual dose: 2 to 2.5 mg/kg total. Maintenance infusion: Titrate to 100 to 200 mcg/kg/min (6 to 12 mg/kg/hr). Maintenance intermittent bolus: 25 to 50 mg increments, as needed. ELDERLY, DEBILITATED OR ASA III/IV: (American Society of Anesthesiologists classification of heart disease, cardiac function, angina and physical status used to assign risk for anesthesia.) IV 20 mg q 10 sec until onset. Usual dose: 1 to 1.5 mg/kg). Maintenance infusion: Titrate to 50 to 100 mcg/kg/min (3 to 6 mg/kg/hr. NEUROSURGICAL PATIENTS: IV Induction: 20 mg q 10 sec until onset. Usual dose: 1 to 2 mg/kg. Maintenance infusion: 100 to 200 mcg/kg/min (6 to 12 mg/kg/hr). CHILDREN (³ 3 YR): IV Induction: 2.5 to 3.5 mg/kg over 20 to 30 sec. Maintenance infusion: Titrate to 125 to 300 mcg/kg/min (7.5 to 18 mg/kg/hr).

Sedation

ADULTS (< 55 YR): IV Initiation: 100 to 150 mcg/kg/min (6 to 9 mg/kg/hr) for 3 to 5 min (preferred method) or slow injection of 0.5 mg/kg over 3 to 5 min; follow by maintenance infusion. Maintenance: 25 to 75 mcg/kg/min (1.5 to 4.5 mg/kg/hr) (preferred method) or incremental bolus doses of 10 to 20 mg. ELDERLY, DEBILITATED, OR ASA III/IV: IV Initiation: Same as adults; not as rapid bolus. Maintenance: 20% reduction of adult dose; avoid rapid bolus doses.

ICU Sedation

ADULTS: IV Initiation: 5 mcg/kg/min (0.3 mg/kg/hr) for ³ 5 min; increments of 5 to 10 mcg/kg/min (0.2 to 0.6 mg/kg/hr) over 5 to 10 min may be used until desired level of sedation is achieved. Maintenance: 5 to 50 mcg/kg/min (0.3 to 3 mg/kg/hr) or higher may be required; use minimum dose required for sedation.

 Interactions

CNS depressants (eg, barbiturates, benzodiazepines, narcotics): Increased CNS depression. INCOMPATIBILITIES: IV: Do not mix with other therapeutic agents prior to administration. Avoid mixing blood or plasma in same IV catheter.

 Lab Test Interferences None well documented.

 Adverse Reactions

CV: Myocardial ischemia; hypotension; bradycardia; decreased cardiac output; hypertension (especially in children). CNS: Amorous behavior; movement hypotonia; hallucinations; neuropathy; opisthotonos. DERM: Rash. EENT: Conjunctival hyperemia; nystagmus. META: Hyperlipidemia. RESP: Apnea; cough; respiratory acidosis during weaning. OTHER: Asthenia; burning, stinging or pain at injection site; fever.

 Precautions

Pregnancy: Category B. Lactation: Excreted in breast milk. Labor/delivery: Not recommended for obstetrical anesthesia (neonatal depression). Children: Not recommended for children < 3 yr. Special-risk patients: Use lower induction and maintenance doses in elderly, debilitated and ASA III/IV patients and monitor continuously for sign of hypotension or bradycardia. Use with caution in patients with lipid metabolism disorders, because propofol is an emulsion. Epileptics may be at risk of convulsions during recovery phase. Avoid significant decreases in mean arterial pressure (and cerebral perfusion) in patients with increased intracranial pressure or impaired cerebral circulation. Anaphylaxis: Has occurred rarely; relationship to drug has not been established.

 Administration/Storage

• Should be administered only by personnel who are trained in administration of general anesthesia and familiar with drug.
• Administer only in settings in which resuscitation equipment is immediately available.
• Shake well before use. Do not use if there is evidence of separation of phases of emulsion.
• Maintain strict aseptic technique in handling; rapid growth of organisms may occur if contaminated.
• Dilute with 5% Dextrose Injection, but do not dilute to concentration < 2 mg/ml. Drug is compatible with 5% Dextrose, USP; Lactated Ringers Injection, USP; Lactated Ringers and 5% Dextrose Injection; 5% Dextrose and 0.45% Sodium Chloride Injection, USP; 5% Dextrose and 0.2% Sodium Chloride Injection, USP.
• Minimize pain associated with administration by infusing into larger veins.
• Discard any unused portions of drug or solution at end of anesthetic procedure; do not keep for > 6 hr.
• In ICU sedation discard after 12 hr if administered directly from vial or after 6 hr if transferred to syringe or other container.
• Store at room temperature. Do not refrigerate. Protect from light.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies. Note epilepsy, cardiac and respiratory status and lipid disorders.
• Monitor patient carefully; be especially alert for apnea, hypotension, or cardiovascular depression (bradycardia). Notify physician if these symptoms occur.
• Be prepared for possible alterations in mental status including confusion, combativeness and hallucinations and for possible neurological changes, including increases in movement, hypertonia, clonic/myoclonic movement and bucking, jerking, or thrashing.
• Monitor for increases in serum triglycerides or serum turbidity in patients at risk of hyperlipidemia and notify physician.
• Observe for possible respiratory acidosis during weaning after prolonged administration.

 Patient/Family Education

• Advise patient that mental alertness, coordination, and physical dexterity may be impaired for some time after administration.

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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts