Propofol

General

• Type: Sedative agent
• Dosage Forms: 10mg/mL
• Common Trade Names: Diprivan

Adult Dosing

Standard Induction Sedation

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

Other

• Maintenance dose for sedation between 0.1-0.2 mg/kg/min or 25-50 mg IV PRN in healthy patients < 55 years of age
• 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 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 2.5-3.5 mg/kg IV
• Procedural sedation 1 mg/kg (max 40 mg), then 0.5 mg/kg PRN (max 20 mg)
• Pediatric population especially at risk for propofol infusion syndrome (PRIS)

Special Populations

• Pregnancy Rating: Drug of choice for induction in pregnancy (only Category B induction agent)
• Lactation risk:
• Renal Dosing
  • Adult
    • No adjustment necessary
  • Pediatric
    • No adjustment necessary
• Hepatic Dosing
  • Adult
    • No adjustment necessary
  • Pediatric
    • No adjustment necessary

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: 40 minutes (initial); 24-72 hr (after 10-day infusion)
• 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

See Also

• Sedation (Main)
• Ketofol
• Propofol infusion syndrome