Understanding Anesthesiology - The Global Regional Anesthesia ...

PROPOFOL
Class
Alkylphenol intravenous anesthetic agent. Used for induction
of general anesthesia. Can also be used for
maintenance of anesthesia or for sedation, in each case
by continuous infusion.
Mechanism of action
Not well described.
Dose
Induction: 2-2.5 mg/kg IV for adults
Induction: 3-4 mg/kg IV for children
Maintenance of anesthesia:100-200 ug/kg/minute
Sedation: 40-100 ug/kg/minute
Onset
Within one arm-brain circulation time (approximately
20 seconds).
Duration
Approximately 5-8 minutes after single induction dose.
Offset of effect is more prolonged when administered
as a continuous infusion.
Elimination
Rapid redistribution away from central nervous system
(CNS) into lean body compartment accounts for
prompt awakening. Metabolized by liver and extrahepatic
sites then excreted by kidney.
Effects
CNS
Profound CNS depressant, potentiating the depressant
effects of opioids, sedatives and volatile anesthetics. Decreases
cerebral metabolic rate and intracranial pressure.
Occasionally excitement, tonic-clonic movements
or opisthotonus is seen on induction with propofol.
CVS
Causes direct myocardial depression and vasodilation
leading to hypotension. Propofol must be used with
caution in patients with poor left ventricular function
or critical coronary artery insufficiency or in those who
are seriously ill or debilitated.
Respiratory
Depression of respiratory centre leads to brief apnea.
Propofol effectively blunts the airway’s response to manipulation
thus hiccoughing and bronchospasm are
rarely seen.
Misc.
Pain on injection seen in up to 20%. Mild anti-emetic
properties. Patients often experience pleasant dreams
under anesthesia followed by a smooth, clear-headed
emergence. Strict aseptic technique must be used when
handling propofol as the vehicle is capable of supporting
rapid growth of micro-organisms.
Contraindications
Egg or soy allergy.
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