Propofol

Background

• Rapid onset (90-100 seconds) and short duration (2-8 minute)
• Wake up after induction dose usually 8-10 min
• Seizure-like activity possible during induction, but safe in seizure disorder (most studies actually support anticonvulsant effect)
• Has significant anti-emetic activity
• Drug of choice for induction in pregnancy (only Category B induction agent)
• Associated with static or reduced intracranial pressure in head injured patients requiring ICU Sedation

Contraindications

• Allergy to soy or eggs
• Hypotension
• Aortic stenosis

Higher Risk

• Pts >55 yr
• Debilitated patients
• Pts w/ 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

Side Effects

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

Dose

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 25-50 mg IV prn in healthy pts < 55 yoa
• Antiemetic dosing, 10-20 mg 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 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

• Induction (3-16 yo) at 2.5-3.5 mg/kg IV
• 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.