• Induction of general anesthesia in children >3 yr and adults.
• Maintenance of balanced anesthesia when used with other agents in children >2 mo and adults.
• Initiation and maintenance of monitored anesthesia care.
• Sedation of intubated, mechanically ventilated patients in intensive care units (ICUs).

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 pre-procedure sedation; may affect brain development in children <3 yr
• Geri: Lower induction and maintenance dose ↓ recommended in older adults.

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.

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.
• Serious bradycardia can occur with concurrent use of fentanyl in children.
• ↑ risk of hypertriglyceridemia with intravenous fat emulsion.

(Generic available)

• Lipid emulsion for injection: 10 mg/mL;

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 first 10–15 min after induction, then ↓ by 30–50% during first 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 yr–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 first 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.

Diprivan

• Short-acting hypnotic. Mechanism of action is unknown.
• Produces amnesia.
• Has no analgesic properties.

• Induction and maintenance of anesthesia.

Therapeutic Classification: general anesthetics

Absorption: IV administration results in complete bioavailability.

Distribution: Rapidly and widely distributed. Crosses the blood-brain barrier well; rapidly redistributed to other tissues.

Protein Binding: 95–99%.

Metabolism/Excretion: Rapidly metabolized by the liver. Primarily excreted in urine as metabolites.

Half-life: 3–12 hr (blood-brain equilibration half-life 2.9 min).

(loss of consciousness)

†Time to recovery is 8 min (up to 19 min if opioid analgesics have been used).

• Inform patient that this medication will decrease mental recall of the procedure.
• May cause drowsiness or dizziness. Advise patient to request assistance prior to ambulation and transfer and to avoid driving or other activities requiring alertness for 24 hr following administration.
• Advise patient to avoid alcohol or other CNS depressants, including opioids, without the advice of a health care professional for 24 hr following administration.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding. Monitor neonates for hypotonia and sedation following maternal exposure to propofol.

PROE-poe-fol