Propofol

General

Adult Dosing

Standard Induction Sedation

  • Induction = 0.5-1mg/kg IV over 10s, followed by 0.5mg/kg every 2-3 minutes as needed
  • Small incremental doses (10-30mg) can slowly be administered to effect

Other

  • Maintenance dose for sedation between 0.1-0.2/kg/min or 25-50mg IV PRN in healthy patients < 55 years of age
  • Antiemetic dosing, 10-20mg IV or 10 μg/kg/min infusion

Adjunctive medications

  • Fentanyl or morphine (propofol does not provide analgesia)
  • NS for transient hypotension
  • Lidocaine flush (to reduce injection pain)

ICU Sedation

  • 5-50 mcg/kg/min IV, increase 5 mcg/kg/min q10min
  • Avoid prolonged use, especially of high doses, to avoid propofol infusion syndrome (PRIS)
  • PRIS usually associated with >65 mcg/kg/min for >24hrs, and critically ill patients with increased endogenous glucocorticoids and catecholamines
    • PRIS: Heart failure, Rhabdomyolysis, metabolic acidosis, renal failure
  • Propofol drip of these high dosages can be seen in post-intubation status epilepticus (drip 2-10mg/kg/hr)

Pediatric Dosing

  • Induction (3-16 yo) at 2.5-3.5mg/kg IV
  • Procedural sedation 1mg/kg (max 40mg), then 0.5mg/kg PRN (max 20mg)

Special Populations

  • Pregnancy Rating: Drug of choice for induction in pregnancy (only Category B induction agent)
  • Lactation risk:
  • Renal Dosing
    • Adult
    • Pediatric
  • Hepatic Dosing
    • Adult
    • Pediatric

Contraindications

  • Allergy to class/drug
  • Allergy to soy or eggs
  • Hypotension
  • Aortic stenosis

Higher Risk

  • Patients >55 years old
  • Debilitated patients
  • Patients with significant underlying illness (i.e. ASA physical status score III or IV)
    • Optimize volume status before administration
    • Largest decrease in systemic BP (vasodilation with only small increase in HR) compared with other induction drugs

Adverse Reactions

  • Respiratory depression
  • Transient hypotension
  • Pain at injection site (inject lidocaine 20-40mg IV and fentanyl 50 mcg IV first)
  • Hypertriglyceridemia - check TG levels in ICU setting
  • Cardiac arrest (patients with significant cardiac disease receiving propofol for induction at highest risk)
  • Propofol infusion syndrome (PRIS)

Pharmacology

  • Half-life:
  • Metabolism: Hepatic
  • Excretion: Renal
  • Mechanism of Action: GABA agonist
  • Rapid onset (90-100 seconds) and short duration (2-8 minute)
  • Wake up after induction dose usually 8-10 min

Comments

  • Seizure-like activity possible during induction, but safe in seizure disorder (most studies actually support anticonvulsant effect)
  • Has significant anti-emetic activity
  • Associated with static or reduced intracranial pressure in head injured patients requiring ICU Sedation[1]

See Also

References

  1. McKeage, K. and Perry, C. M. (2003) ‘Propofol’, CNS Drugs, 17(4), pp. 235–272.