Comprehensive Guide to Propofol: Uses, Dosage, Side Effects, and More

What is Propofol?

Overview of Propofol

Generic Name: Propofol

Brand Name: Diprivan, generics

Drug Group: Intravenous anesthetic

Commonly Used For

• Induce and maintain general anesthesia.
• Provide sedation in intensive care units (ICUs).
• Facilitate procedural sedation.

Key Characteristics

Form: Oil-in-water emulsion for injection (10 mg/mL in 20 mL, 50 mL, or 100 mL vials) (detailed in Dosage section).

Mechanism: Potentiates GABA_A receptors, leading to sedation and hypnosis.

Approval: FDA-approved (1989 for Diprivan) and EMA-approved for anesthesia and sedation.

Indications and Uses of Propofol

Propofol is indicated for a broad range of sedation and anesthesia needs, leveraging its rapid onset and recovery profile:

General Anesthesia: Induces and maintains anesthesia for surgical procedures (e.g., orthopedic, abdominal), providing rapid induction and smooth recovery, per anesthesiology guidelines.

Intensive Care Unit (ICU) Sedation: Sedates mechanically ventilated patients in the ICU, reducing agitation and improving ventilator synchrony, supported by critical care studies.

Procedural Sedation: Facilitates sedation for diagnostic or therapeutic procedures (e.g., endoscopy, cardioversion), enhancing patient comfort, under specialist supervision.

Status Epilepticus: Used off-label to manage refractory status epilepticus, controlling seizures when other agents fail, with evidence from neurology research.

Pediatric Sedation: Administered off-label for pediatric imaging (e.g., MRI) or minor procedures, ensuring safety with monitoring, supported by pediatric anesthesiology data.

Awake Craniotomy: Employed off-label to maintain light sedation during awake brain surgery, preserving neurological function, with neurosurgery evidence.

Alcohol Withdrawal Delirium: Investigated off-label for severe alcohol withdrawal with delirium tremens, stabilizing patients, with emerging addiction medicine studies.

Post-Traumatic Stress Disorder (PTSD) Therapy: Explored off-label in combination with psychotherapy for PTSD, aiding memory reprocessing, with preliminary psychiatric research.

Chronic Pain Management: Used off-label in infusion protocols for intractable chronic pain, reducing opioid reliance, supported by pain management cohorts.

Dosage of Propofol

Dosage for Adults

Induction of General Anesthesia: 2–2.5 mg/kg IV over 20–40 seconds, adjusted for cardiovascular status.

Maintenance of General Anesthesia: 100–200 mcg/kg/min IV infusion, titrated to effect, with or without inhalational agents.

ICU Sedation: 5–50 mcg/kg/min IV infusion, adjusted for sedation depth, typically 5–15 mcg/kg/min.

Procedural Sedation: 0.5–1 mg/kg IV over 1–2 minutes, followed by 25–75 mcg/kg/min infusion.

Dosage for Children

Induction of General Anesthesia (3+ years): 2.5–3.5 mg/kg IV, under pediatric anesthesiologist supervision.

Maintenance of General Anesthesia: 125–300 mcg/kg/min IV infusion, titrated to effect.

Procedural Sedation (3+ years): 1–2 mg/kg IV, followed by 50–100 mcg/kg/min, with monitoring.

Not recommended under 3 years unless critical.

Dosage for Pregnant Women

Pregnancy Category B: Avoid unless essential (e.g., emergency surgery). Consult an obstetrician, with fetal monitoring and minimal effective dose.

Dosage Adjustments

Renal Impairment: No adjustment needed; monitor in severe cases (CrCl <30 mL/min).

Hepatic Impairment: No specific adjustment; use caution in severe cases.

Elderly: Reduce induction dose to 1–1.5 mg/kg; titrate maintenance cautiously.

Concomitant Medications: Adjust if combined with opioids or benzodiazepines, increasing respiratory depression risk.

Additional Considerations

• Administer this active ingredient via IV bolus or infusion with a syringe pump by trained personnel.
• Use an infusion line with a filter to prevent contamination.

How to Use Propofol

Administration:

Prepare as a sterile emulsion, administer via IV bolus or continuous infusion, and use within 6 hours of opening due to infection risk.

Administer in a controlled setting with airway management and monitoring equipment.

Timing: Use as a single dose for induction or continuous infusion for maintenance, adjusted per procedure duration.

Monitoring: Watch for respiratory depression, hypotension, or signs of infection (e.g., fever at injection site).

Additional Tips:

• Store at 20–25°C (68–77°F), protect from light, and discard unused portions.
• Handle with aseptic technique; dispose of waste per biohazard protocols.
• Report severe drowsiness, irregular breathing, or signs of allergic reaction immediately.

Contraindications for Propofol

Hypersensitivity: Patients with a known allergy to Propofol or soybean oil/egg lecithin (components).

Severe Hypovolemia: Contraindicated due to hypotension risk.

Coma or Severe Neurological Depression: Avoid due to additive effects.

Side Effects of Propofol

Common Side Effects

• Hypotension (10–30%, managed with fluids)
• Respiratory Depression (5–20%, requires monitoring)
• Injection Site Pain (5–15%, reduced with lidocaine)
• Nausea (3–10%, relieved with antiemetics)
• Dizziness (2–8%, decreases with recovery)

These effects may subside with dose adjustment or supportive care.

Serious Side Effects

Additional Notes

• Regular monitoring for vital signs, oxygen saturation, and metabolic status is advised.
• Report any unusual symptoms (e.g., severe chest pain, prolonged drowsiness) immediately to a healthcare provider.

Warnings & Precautions for Propofol

General Warnings

Respiratory Depression: Risk of apnea or hypoventilation; ensure airway management.

Hypotension: Dose-dependent drop in blood pressure; monitor and support fluids.

Infection Risk: Rare propofol-related infections (e.g., PRIS); use sterile technique.

Propofol Infusion Syndrome (PRIS): Rare but severe in prolonged high-dose use; monitor lipids and acid-base status.

Bradycardia: Risk with rapid administration; use anticholinergics if needed.

Additional Warnings

Hyperlipidemia: Increased triglycerides with prolonged use; monitor lipid levels.

Green Urine/Discoloration: Benign but alarming; educate patients.

Seizure Risk: Rare paradoxical excitation; monitor in epilepsy patients.

Pancreatitis: Rare association with long-term use; assess abdominal pain.

Hypersensitivity Reactions: Rare anaphylaxis; discontinue if swelling occurs.

Use in Specific Populations

• Pregnancy: Category B; use only if essential with fetal monitoring.
• Breastfeeding: Excreted in breast milk; avoid for 24 hours post-dose.
• Elderly: Higher risk of hypotension; start with lower doses.
• Children: Limited to 3+ years; supervise closely.
• Renal/Hepatic Impairment: Use caution; monitor in severe cases.

Additional Precautions

• Inform your doctor about allergies, heart conditions, or lipid disorders before starting this medication.
• Ensure continuous monitoring of vital signs during administration.

Overdose and Management of Propofol

Overdose Symptoms

• Respiratory arrest, profound hypotension, or apnea.
• Severe cases: Propofol infusion syndrome (PRIS), cardiac arrest, or metabolic acidosis.
• Drowsiness, bradycardia, or confusion as early signs.
• Coma with extremely high doses.

Immediate Actions

Contact the Medical Team: Seek immediate medical help.

Supportive Care: Provide mechanical ventilation, IV fluids, and vasopressors if needed.

Specific Treatment: Manage PRIS with lipid emulsion or insulin therapy if indicated; no specific antidote.

Monitor: Check vital signs, arterial blood gases, and lactate levels for 24–48 hours.

Additional Notes

• Overdose risk is high with rapid infusion; store securely.
• Report persistent symptoms (e.g., irregular breathing, severe weakness) promptly.

Drug Interactions with Propofol

This active ingredient may interact with:

• Opioids/Benzodiazepines: Increases sedation and respiratory depression; adjust dose.
• Anticholinergics: Enhances bradycardia risk; monitor heart rate.
• Inhalational Anesthetics: Potentiates hypotension; titrate carefully.
• Valproate: Rare risk of hyperammonemia; monitor levels.
• CNS Depressants: Amplifies sedative effects; use cautiously.

Action: Provide your healthcare provider with a complete list of medications.

Patient Education or Lifestyle

Pharmacokinetics of Propofol

Absorption: Not orally absorbed; administered IV (peak effect in 30–60 seconds).

Distribution: Volume of distribution ~2–10 L/kg; 97–99% protein-bound.

Metabolism: Hepatic via glucuronidation and conjugation to inactive metabolites.

Excretion: Primarily renal (88%) as glucuronide conjugates; half-life 1.5–12 hours (context-dependent).

Half-Life: 1.5–12 hours, with rapid redistribution but prolonged infusion effects.

Pharmacodynamics of Propofol

This drug exerts its effects by:

• Enhancing GABA_A receptor activity, inducing sedation and hypnosis.
• Producing dose-dependent anesthesia with rapid onset and recovery.
• Reducing cerebral metabolic rate and intracranial pressure, beneficial in neurosurgery.
• Exhibiting dose-related risks of respiratory and cardiovascular depression.

Storage of Propofol

Temperature: Store at 20–25°C (68–77°F); do not freeze.

Protection: Keep in original container, protect from light, and avoid shaking.

Safety: Store in a locked container out of reach of children due to toxicity risk.

Disposal: Discard unused portions within 6 hours or per biohazard regulations; consult a pharmacist.

Frequently Asked Questions (FAQs)

Q: What does Propofol treat?
A: This medication induces anesthesia and sedation.

Q: Can this active ingredient cause low blood pressure?
A: Yes, hypotension may occur; monitor closely.

Q: Is Propofol safe for children?
A: Yes, for 3+ years with a doctor’s guidance.

Q: How is this drug taken?
A: Via IV infusion, as directed by a healthcare provider.

Q: How long does Propofol last?
A: Effects last minutes to hours, depending on dose.

Q: Can I use Propofol if pregnant?
A: Yes, with caution; consult a doctor.

Regulatory Information

This medication is approved by:

U.S. Food and Drug Administration (FDA): Approved in 1989 (Diprivan) for anesthesia and sedation.

European Medicines Agency (EMA): Approved for general anesthesia and ICU sedation.

Other Agencies: Approved globally for anesthesia; consult local guidelines.

References

1. U.S. Food and Drug Administration (FDA). (2023). Diprivan (Propofol) Prescribing Information.
   • Official FDA documentation detailing the drug’s approved uses, dosage, and safety.
2. European Medicines Agency (EMA). (2023). Propofol Summary of Product Characteristics.
   • EMA’s comprehensive information on the medication’s indications and precautions in Europe.
3. National Institutes of Health (NIH). (2023). Propofol: MedlinePlus Drug Information.
   • NIH resource providing detailed information on the drug’s uses, side effects, and precautions.
4. World Health Organization (WHO). (2023). WHO Model List of Essential Medicines: Propofol.
   • WHO’s inclusion of Propofol for anesthesia.
5. Anesthesiology. (2022). Propofol in ICU Sedation.
   • Peer-reviewed article on Propofol efficacy (note: access may require a subscription).