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
5. Drug of choice for induction in pregnancy (only Category B induction agent)
6. Associated with static or reduced intracranial pressure in head injured patients requiring ICU Sedation

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 and fentanyl 50 mcg IV first)
4. Cardiac arrest (patients with significant cardiac disease receiving propofol for induction at highest risk)
5. Propofol infusion syndrome (PRIS): See below

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 0.1-0.2/kg/min or 25-50 mg IV prn in healthy pts < 55 yoa
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)

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 pts with increased endogenous glucocorticoids and catecholamines
  • PRIS: Heart failure, Rhabdomyolysis, metabolic acidosis, renal failure
• Propofol gtt of these high dosages can be seen in post-intubation status epilepticus (gtt 2-10 mg/kg/hr)

Pediatric Population

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

See Also

• Sedation (Main)

References

• Stoelting RK, Miller RD. Basics of Anesthesia. 5th ed. Philadephia, PA: Churchill Livingstone Elsevier; 2007.
• Brophy GM. Guidelines for the Evaluation and Management of Status Epilepticus. J Neurocrit Care. 2012, Apr;17(1):3-23.