PROPOFOL

PHARMACODYNAMICS
• Decreases blood going to brain, oxygen
consumption in brain, pressure inside the cranium

• Causes Amnesia (midaz=propofol>thiopentone)

• Anti convulsant action

• No interference to electrocorticographic reading in

awake craniotomy
• Decrease in Systolic Blood pressure
(most prominent)

• Decrease in sympathetic activity

causing relaxation of vessels

• Decrease hypertensive response to

LMA insertion

• Must be cautious in elderly,

hypotensive patients and patients
with left ventricular dysfunction.
• It causes apnea/depression of ventilation

• It causes depression of airway reflexes and helps in

insertion of LMA.

• lnduces bronchodilation in patients with COPD

• Always check on the preservative used in propofol

preparation.

• If METABISULPHITE is used as a preservative, it has

higher chances of causing bronchoconstriction.

• Patients with allergy history are prone to

bronchoconstriction even with common preparation
of propofol
CLINICAL USES OF PROPOFOL

• Maintenance of GA :- 100 – 300 μg/kg/min

 INDUCTION FOR SURGERY
• Children require high induction doses  larger central distribution
volume and high clearance rate

• Elderly require low doses  smaller central distribution volume;

decreased clearance rate; increased pharmacodynamic activity

• Complete awakening without residual CNS effects is characteristic

• CONTEXT SENSITIVE HALF-TIME – Time required
for blood/plasma concentration of drug to decrease
by 50%after discontinuation of drug administration

• The CONTEXT SENSITIVE HALF-TIME for propofol

infusions of up to 8 hours is less than 40 minutes
INTRAVENOUS SEDATION
• Preferred drug as it has short context-sensitive half time

• No residual sedation less nausea & vomiting

• 25 – 100 μg/kg/minute IV

• Sedation for mechanically ventilated patients in ICU (post op, head

injury, children etc.,)
• Status Epilepticus, refractory (children and adults)

• Treatment of refractory PONV

• DOC: Day care surgery (rapid & clear recovery)

• DOC: LMA insertion(depression of airway reflexes)

• Anti emetic property  10 – 15mg IV

• Anti pruritic property  10mg IV

• Anti convulsant  >1mg/kg IV decreases seizure duration

Propofol 2% vial
Lignocaine confusion
CONTRAINDICATIONS
• Previous history of hypersensitivity for this drug

• Relative  Patients with low blood pressure

Side effects
• Bradycardia (decreased heart rate)
• Risk of infection
• Pain on injection
• Hypertriglyceridemia on prolonged infusion
• Potential for pulmonary embolism
• Allergic response
• Propofol Infusion Syndrome(PIS)
• Abuse potential and Intense dreaming, Hallucinations(Esp. with low
doses)
Bradycardia related death
• Profound bradycardia and asystole  1.4 in 1,00,000  even in
healthy adults receiving prophylactic anticholinergics

• Atropine responses are decreased

• Treatment  β agonist like Epinephrine

Propofol Infusion Syndrome
• Caused when infusions > 4-5mg/kg/hr given >48 hrs given

CLINICAL FEATURES:-

Primary
1. ECG changes like ST elevation in leads V1 to V3, supraventricular tachy, brady
2. New onset severe metabolic acidosis
3. Rhabdomyolysis
Secondary
1. Lipidemia
2. Increased potassium
3. Acute kidney injury
4. Fever
5. Cardiac dysfunction
6. Deranged Liver enzymes
7. Raised Serum Lactate
8. Excretion of green urine
Prevention
• Infusions < 4mg/kg/hr are recommended
• Co-administration of other sedatives
• If high doses required close monitoring of pH, lactate and creatine
kinase
• Accurate calculation of amount of drug going in
• Ensure a continuous carbohydrate supply
Treatment
• Stop the infusion immediately
• Adequate fluid management
• Arrhythmia or hypotension treatment
• Hemofiltration
Bacterial growth
• Supports growth of E.coli & Pseudomonas aeruginosa
• Recommended
1. An aseptic technique to handle propofol and loading propofol
2. Contents should be immediately drawn into sterile syringe after opening
and administered promptly
3. Discard OT 6 hours ICU 12 hours
Propofol in Pregnancy
• It can be used for short duration surgical procedures
• Propofol crosses placenta and enter fetal blood stream
• High doses like 9mg/kg will effect fetus neurodevelopment
• Doses at range of <2mg/kg must be used