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Propofol

    DEA Class;  Rx

    Common Brand Names; Diprivan

    • General Anesthetics, Systemic; 

    Intravenous general anesthetic and sedative
    Used for general anesthesia induction and maintenance, monitored anesthesia care (MAC) sedation, combined sedation and regional anesthesia, and intensive care unit (ICU) sedation of mechanically ventilated patients
    Prolonged, high-dose infusions for ICU sedation associated with metabolic derangements and organ system failures, referred to as propofol-related infusion syndrome (PRIS)

    Indicated for general anesthesia induction.

    For general anesthesia maintenance.
    For monitored anesthesia care sedation.
    For sedation induction and sedation maintenance of mechanically ventilated intensive care patients.
    For procedural sedation.

     

    Documented hypersensitivity, egg allergy, soybean/soy allergy

    • Hypotension (peds 17%; adults 3-26%)
    • Apnea lasting 30-60 sec (peds 10%; adults 24%)
    • Apnea lasting >60 sec (peds 5%; adults 12%)
    • Movement (peds 17%; adults 3-10%)
    • Injection site burning/stinging/pain (peds 10%; adults 18%)
    • Respiratory acidosis during weaning (3-10%)
    • Hypertriglyceridemia (3-10%)
    • Hypertension (peds 8%)
    • Rash (peds 5%; adults 1-3%)
    • Pruritus (1-3%)
    • Arrhythmia (1-3%)
    • Bradycardia (1-3%)
    • Cardiac output decreased (1-3%; concurrent opioid use increases incidence)
    • Tachycardia (1-3%)
    • Arterial hypotension
    • Anaphylaxis
    • Asystole
    • Bronchospasm
    • Cardiac arrest
    • Seizures
    • Opisthotic rxn
    • Pancreatitis
    • Pulmonary edema
    • Phlebitis
    • Thrombosis
    • Renal tubular toxicity

    Drug vehicle (emulsion) is capable of supporting rapid growth of microorganisms; proper aseptic technique is imperative

    Closely monitor patients with anemia, hepatic impairment, myxedema, or renal impairment

    Risk of potentially fatal propofol infusion syndrome in ICU patients

    May cause hypotension, especialy if patient is hypovolemic or if bolus dosing is used; reduction in mean arterial pressure may exceed 30%; use caution in patients who arehemodynamically unstable, hypovelimic, or have abnormally low vascular tone

    Use with caution in patients with severe cardiac disease (<50% ejection fraction) or hypotension; may have more profound adverse cardiovascular responses to propofol

    Use with caution in patients with increased intracranial pressure or impaired cerebral circulation; mean arterial pressure may decrease substantially; cerebral perfusion may subsequently decrease; consider continuous infusion or administer as a slow bolus

    Prefilled syringes may have potential to support growth of various microorganisms dispite additives intended to suppress microbial growth; strictly adhere to recommendations in product labeling for handling and administering propofol

    Use caution in patients with respiratory disease and history of epilepsy or seizures; seizures may occur during recovery phase

    Propofol lacks analgesic properties; pain management requires specific use of analgesic agents, at effective dosages; titrate propofol separately from analgesic agent

    Do not give bolus to ASA III/IV patients; rapid bolus doses will increase cardiorespiratory effects (ie, hypotension, apnea, airway obstruction)

    Significant hypertriglyceridemia may be observed during infusion of propofol; 0.1 g lipid (1.1 kcal) per 1 mL propofol

    Accidental extravasation may result in tissue necrosis

    Risk of chills, fever, body aches

    Propofol infusion syndrome may occur; this is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, and cardiac and renal failure (esp with prolonged, high-dose infusions >5 mg/kg/hr for >48 hr)

    Pregnancy category: B

    Lactation: Excreted in breast milk; effect on nursing infant not known

    Specific maximum dosage information is not available. Dosage must be individualized based on clinical response.

    Propofol

    injectable solution

    • 10mg/mL