Propofol

Indications:

  • Induction or maintenance of anesthesia
  • Sedation in intubated, mechanically ventilated ICU patients 
  • (Off label) post operative nausea and vomiting rescue
  • (Off label) refractory status epileptics 

Mechanism: short acting, lipophilic IV general anesthetic 

  • Global CNS depression, agonist of GABA-A and reduced glutamergic activity through NMDA receptor blockade 
  • Accumulates in tissues and redistributes into plasma when drug is discontinued 

Monitoring:

  • Adverse reactions: hypotension, involuntary body movements, local site reactions, apnea, hypertriglyceidemia 

Propofol Infusion Syndrome:

  • Acute refractory bradycardia leading to asystole, in the presence of one or more: metabolic acidosis, rhabdomyolysis, hyperlipidemia, CV collapse and enlarged or fatty liver
  • Dose and duration dependent – associated with high doses (>67mcg/kg/min) and prolonged use (>48 hrs)
  • Risk factors: young age, critical illness, high fat and low carb intake, steroid treatment 
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