Propofol

Background

1. Rapid onset (90-100 seconds) and short duration (2-8 minute)
2. Wake up after induction dose usually 8-10 min
3. Seizure-like activity possible during induction, but safe in seizure disorder (most studies actually support anticonvulsant effect)
4. Has significant anti-emetic activity

Contraindications

1. Allergy to soy or eggs
2. Hypotension
3. Aortic stenosis

Higher Risk

1. Pts >55 yr
2. Debilitated patients
3. Pts w/ significant underlying illness (i.e. ASA physical status score III or IV)
   1. Optimize volume status before administration
   2. Largest decrease in systemic BP (vasodilation with only small increase in HR) compared with other induction drugs

Side Effects

1. Respiratory depression
2. Transient hypotension
3. Pain at injection site (inject lidocaine 20-40mg IV first)

Dose

Standard Induction Sedation

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

Other

1. Maintenance dose for sedation between 25-75 μg/kg/min
2. Antiemetic dosing, 10-20 mg IV or 10 μg/kg/min infusion

Adjunctive medications

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

Pediatric Population

1. Same dosing

See Also

• Sedation (Main)

References

Stoelting RK, Miller RD. Basics of Anesthesia. 5th ed. Philadephia, PA: Churchill Livingstone Elsevier; 2007.