propofol

ROUTE	ONSET	PEAK	DURATION‡
IV	40 sec	unknown	3–5 min

Contraindicated in:

Hypersensitivity to propofol, soybean oil, egg lecithin, or glycerol;
OB: Crosses placenta; may cause neonatal depression; may affect child's brain development when used during 3rd trimester.

Use Cautiously in:

Cardiovascular disease;
Lipid disorders (emulsion may have detrimental effect);
↑intracranial pressure;
Cerebrovascular disorders;
Hypovolemic patients (lower induction and maintenance dosage recommended);
Lactation: Safety not established in breastfeeding;
Pedi: Not recommended for induction of anesthesia in children <3 yr or for maintenance of anesthesia in infants <2 mo; not for ICU or preprocedure sedation; may affect brain development in children <3 yr;
Geri: Lower induction and maintenance dose ↓ recommended in older adults.

Adv. Reactions/Side Effects ⬆ ⬇

CV: bradycardia, hypotension, hypertension

Derm: flushing

GI: abdominal cramping, hiccups, nausea, vomiting

GU: discoloration of urine (green)

Local: burning, pain, stinging, coldness, numbness, tingling at IV site

MS: involuntary muscle movements, perioperative myoclonia

Neuro: dizziness, headache

Resp: apnea, cough

Misc: fever, PROPOFOL INFUSION SYNDROME

Interactions ⬆ ⬇

Drug-drug:

Additive CNS and respiratory depression with alcohol, antihistamines, opioid analgesics, and sedative/hypnotics (dose ↓ may be required).
Theophylline may antagonize the CNS effects of propofol.
Cardiorespiratory instability can occur when used with acetazolamide.
Fentanyl may ↑ risk of serious bradycardia in children.
↑risk of hypertriglyceridemia with intravenous fat emulsion.

Route/Dosage ⬆ ⬇

General Anesthesia

IV (Adults <55 yr): Induction: 40 mg every 10 sec until induction achieved (2–2.5 mg/kg total). Maintenance: 100–200 mcg/kg/min. Rates of 150–200 mcg/kg/min are usually required during 1st 10–15 min after induction and then ↓ by 30–50% during 1st 30 min of maintenance. Rates of 50–100 mcg/kg/min are associated with optimal recovery time. May also be given intermittently in increments of 25–50 mg.
IV Geriatric Patients , Cardiac Patients, Debilitated Patients, or Hypovolemic Patients): Induction: 20 mg every 10 sec until induction achieved (1–1.5 mg/kg total). Maintenance: 50–100 mcg/kg/min (dose in cardiac anesthesia ranges from 50–150 mcg/kg/min depending on concurrent use of opioid).
IV (Adults Undergoing Neurosurgical Procedures): Induction: 20 mg every 10 sec until induction achieved (1–2 mg/kg total). Maintenance: 100–200 mcg/kg/min.
IV (Children 3–16 yr): Induction: 2.5–3.5 mg/kg; use lower dose for children ASA III or IV.
IV (Children 2 mo–16 yr): Maintenance: 125–300 mcg/kg/min (following 1st 30 min of maintenance, rate should be ↓ if possible); younger children may require larger infusion rates compared to older children.

Monitored Anesthesia Care Sedation

IV (Adults <55 yr): Initiation: 100–150 mcg/kg/min infusion or 0.5 mg/kg as slow injection. Maintenance: 25–75 mcg/kg/min infusion or incremental boluses of 10–20 mg.
IV Geriatric Patients , Debilitated Patients, or ASA III/IV Patients): Initiation: Use slower infusion or injection rates. Maintenance: 20% less than the usual adult infusion dose; rapid/repeated bolus dosing should be avoided.

ICU Sedation

IV (Adults ): 5 mcg/kg/min for a minimum of 5 min. Additional increments of 5–10 mcg/kg/min over 5–10 min may be given until desired response is obtained. (Range 5–50 mcg/kg/min.) Dose should be reassessed every 24 hr.

Availability ⬆ ⬇

(Generic available)

Lipid emulsion for injection: 10 mg/mL

Assessment ⬆ ⬇

Assess respiratory status, HR, and BP continuously throughout propofol therapy. Frequently causes apnea lasting ≥60 sec. Maintain patent airway and adequate ventilation. Propofol should be used only by individuals experienced in endotracheal intubation, and equipment for this procedure should be readily available.
Assess level of sedation and level of consciousness throughout and following administration.
ICU sedation: Perform sedation vacation per institution protocol and assess neurological function daily during maintenance to determine minimum dose required for sedation. Maintain minimal level of sedation during these assessments; do not discontinue. Abrupt discontinuation may cause rapid awakening with anxiety, agitation, and resistance to mechanical ventilation.
Monitor for propofol infusion syndrome (severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, cardiac and renal failure). Most frequent with prolonged, high-dose infusions (>5 mg/kg/hr for >48 hr) but has also been reported following large-dose short-term infusions during surgical anesthesia. If prolonged sedation or ↑ dose is required or metabolic acidosis occurs, consider alternative method of sedation.

Lab Test Considerations:

Monitor LFTs, BUN, creatinine, and electrolytes (sodium, potassium, magnesium, calcium).
Monitor triglycerides, CK, and lactic acid in extended use or high doses.

Toxicity and Overdose:

If overdose occurs, monitor BP, HR, and respiratory rates continuously. Maintain patent airway and assist ventilation as needed. If hypotension occurs, treatment includes IV fluids, repositioning, and vasopressors.

Implementation ⬆ ⬇

Do not confuse Diprivan with Diflucan.
- Dose is titrated to patient response.
- Propofol has no effect on the pain threshold. Adequate analgesia should always be used when propofol is used as an adjunct to surgical procedures.

IV Administration:

Propofol is a vesicant. Administer into a large vein. If extravasation occurs, immediately stop infusion. Leave needle/cannula in place temporarily but do not flush the line. Gently aspirate extravasated solution; then remove needle/cannula. Elevate patient's extremity and apply dry cold compresses. Initiate hyaluronidase antidote for refractory cases in addition to supportive management. For hyaluronidase, inject a total of 1 mL (15 units/mL) intradermally or SUBQ as five separate 0.2-mL injections (using a tuberculin syringe) around the site of extravasation; if IV catheter remains in place, administer IV through the infiltrated catheter; may repeat in 30–60 min if no resolution. May also cause injection site pain; may be minimized if larger veins of the forearm or antecubital fossa are used, especially in pediatric patients. Pain may be ↓ by a prior injection of IV lidocaine (1 mL of a 1% solution).
IV Push: Diluent: Usually administered undiluted. If dilution is necessary, use only D5W. Shake well before use. Solution is opaque, making detection of contaminants difficult. Do not use if separation of the emulsion is evident. Contains no preservatives; maintain sterile technique and administer immediately after preparation. Concentration: Undiluted: 10 mg/mL. If dilution is necessary, dilute to concentration 2 mg/mL.
- Discard unused portions and IV lines at the end of anesthetic procedure or within 6 hr. For ICU sedation, discard after 12 hr if administered directly from vial or after 6 hr if transferred to a syringe or other container. Do not administer via filter <5-micron pore size.
- Aseptic technique is essential. Solution is capable of rapid growth of bacterial contaminants. Infections and subsequent deaths have been reported.
Rate: Administer over 3–5 min. Titrate to desired level of sedation. Pedi: Induction doses may be administered over 20–30 sec.
Intermittent/Continuous Infusion: Diluent: Administer undiluted. Allow 3–5 min between dose adjustments to allow for and assess the clinical effects. Concentration: 10 mg/mL.
Rate: Based on patient's weight (see Route/Dosage section).
Y-Site Compatibility:
- acyclovir
- aminophylline
- ampicillin
- aztreonam
- bumetanide
- buprenorphine
- butorphanol
- calcium gluconate
- cangrelor
- carboplatin
- cefazolin
- cefepime
- cefotaxime
- cefotetan
- cefoxitin
- ceftaroline
- ceftobiprole
- cefuroxime
- chlorpromazine
- cisplatin
- clevidipine
- clindamycin
- cyclophosphamide
- cyclosporine
- cytarabine
- dexamethasone
- dexmedetomidine
- diphenhydramine
- doxycycline
- droperidol
- enalaprilat
- ephedrine
- esmolol
- famotidine
- fentanyl
- fluconazole
- fluorouracil
- furosemide
- glycopyrrolate
- granisetron
- haloperidol
- heparin
- hydrocortisone
- hydromorphone
- ifosfamide
- imipenem/cilastatin
- insulin regular
- isoproterenol
- ketamine
- labetalol
- levetiracetam
- lorazepam
- mannitol
- meperidine
- milrinone
- nafcillin
- nalbuphine
- naloxone
- nitroprusside
- norepinephrine
- paclitaxel
- palonosetron
- pentobarbital
- phenobarbital
- potassium chloride
- prochlorperazine
- propranolol
- sodium bicarbonate
- sufentanil
- tigecycline
Y-Site Incompatibility:
- acetaminophen
- amikacin
- calcium chloride
- ceftolozane/tazobactam
- ciprofloxacin
- cisatracurium
- diazepam
- digoxin
- doxorubicin hydrochloride
- eravacycline
- gentamicin
- isavuconazonium
- levofloxacin
- methotrexate
- methylpredisolone
- metoclopramide
- metronidazole
- minocycline
- mitoxantrone
- phenytoin
- plazomicin
- sulbactam/durlobactam
- tobramycin
- verapamil

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of medication to patient or caregiver.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications.
Inform patient that this medication will ↓ mental recall of the procedure.
May cause drowsiness or dizziness. Advise patient to request assistance before ambulation and transfer and to avoid driving or other activities requiring alertness for 24 hr following administration.
Advise patient to avoid alcohol, marijuana, other forms of cannabis, or prescriptions, including opioids, or OTC drugs that may slow CNS actions without the advice of a health care provider for 24 hr following administration.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or if breastfeeding. Monitor neonates for hypotonia and sedation following maternal exposure to propofol.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇