Propofol
Mechanism :
Propofol is an IV hypnotic agent for use in the induction and maintenance of general anesthesia or sedation. I.V. injection of a therapeutic dose of propofol produces hypnosis rapidly and smoothly, usually within 40 seconds from the start of an injection.
Indication :
- Anaesthesia
- Sedative
- Hypnotic
Contraindications :
When general anesthesia or sedation are contraindicated or in patients with a known allergy and/or hypersensitivity to propofol or its components. Administer with caution to patients with hypovolemia, epilepsy, lipid metabolism disorders, or severe cardiac or respiratory disease. Delayed convulsions have been associated with the use of propofol, therefore special care should be taken when it is used for day case procedures. Abrupt discontinuation may provoke rapid awakening, anxiety and agitation.
Dosing :
For induction of anaesthesia:
3-16 years: 2.5-3.5 mg/kg IV perfusion over 20-30 seconds (older children may require lower doses as compared to younger ones).
Maintenance of anesthesia:
2 months-16 years: 0.125-0.3 mg/kg/min IV; after 30 mins, decrease the infusion rate if clinical signs of light anaesthesia are absent; older children may require lower doses compared to ≤5 years.
Sedation prior to procedure:
1-18 years: 1 mg/kg IV loading dose and then 0.5 mg/kg IV.
Adverse Effect :
Respiratory acidosis and depression, apnea, pulmonary edema, anaphylaxis, hypotension, bradycardia, myocardial depression, asystole, fever, headache, dizziness, excitement, rash, pruritus, pain on injection, hypertriglyceridemia, hyperlipidemia, fatal metabolic acidosis, nausea and vomiting, abdominal cramping, green discoloration of urine, myalgia, twitching, clonic, myoclonic movements and convulsions.
Interaction :
CNS depressant: When given concurrently with other CNS depressant drugs sedative effects may be intensified and the possibility of severe respiratory and cardiovascular depression should be considered.
Theophylline: May antagonize effects.
Suxamethonium: Serious bradycardias have been seen when used with suxamethonium inadequate anticholinergic premedication.
ACE inhibitors, Angiotensin II Antagonists, Antihypertensives and Antipsychotics: May increase the hypotensive effects of propofol.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function |
| 10-20 | Dose as in normal renal function |
| <10 | Dose as in normal renal function |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unlikely to be dialysed. Dose as in normal renal function |
| HD | Unlikely to be dialysed. Dose as in normal renal function |
| HDF/High flux | Unlikely to be dialysed. Dose as in normal renal function |
| CAV/VVHD | Unknown dialysability. Dose as in normal renal function |
Hepatic Dose :
No dose adjustment recommended.