Propofol

Adult dosing:

Migraine
  • 10 mg slow IV push, every 5 to 10 minutes, MAX 80 mg; mixed with 1 mL lidocaine 2% per 10 mL of propofol 1%; infuse at rate of 1 mL/10 sec
Procedural sedation
  • 1 mg/kg IV followed by 0.5 mg/kg every 3 to 5 minutes as needed for sedation [6][7][8][9]
Sedation for a mechanically ventilated patient, Intensive care unit
  • 5 mcg/kg/min (0.3 mg/kg/hr) IV infusion for 5 min then titrate in 5 to 10 mcg/kg/min (0.3 to 0.6 mg/kg/hr) increments to achieve desired level of sedation; allow minimum of 5 min between dose adjustments; usual maintenance rates 5 to 50 mcg/kg/min (0.3 to 3 mg/kg/hr) or higher

Pediatric dosing:

General anesthesia
  • (3 to 16 years) induction, 2.5 to 3.5 mg/kg IV over 20 to 30 seconds [4]
  • (2 months to 16 years) maintenance, 125 to 300 mcg/kg/min IV (7.5 to 18 mg/kg/hr) [4]
Procedural sedation
  • 1 mg/kg IV followed by 0.5 mg/kg every 3 to 5 minutes as needed for sedation

Dose Adjustments:

 

  • geriatrics: general anesthesia induction dose, 20 mg IV every 10 seconds until induction onset (1 to 1.5 mg/kg); general anesthesia maintenance dose, 50 to 100 mcg/kg/min (3 to 6 mg/kg/hr); initiation of MAC sedation, most patients similar to healthy adults; maintenance of MAC sedation, most patients require 80% of the usual adult dose [4]
  • cardiac patients: induction of cardiac anesthesia, 20 mg IV every 10 seconds until induction (0.5 to 1.5 mg/kg); maintenance of cardiac anesthesia, IV infusion 100 to 150 mcg/kg/min when propofol is used as the primary agent with an opioid as the secondary agent or 50 to 100 mcg/kg/min when an opioid is the primary agent [4]
  • debilitated, ASA-PS III or IV patients: general anesthesia induction, 20 mg IV every 10 seconds until induction onset (1 to 1.5 mg/kg); general anesthesia maintenance dose, 50 to 100 mcg/kg/min (3 to 6 mg/kg/hr); initiation of MAC sedation, most patients similar to healthy adults (avoid rapid boluses); maintenance of MAC sedation, most patients require 80% of the usual adult dose (avoid rapid boluses) [4]
  • neurosurgical patients: induction of anesthesia 20 mg IV every 10 seconds until induction (1 to 2 mg/kg); maintenance of anesthesia 100 to 200 mcg/kg/min (6 to 12 mg/kg/hour) by IV infusion; initiation of MAC sedation, most patients similar to healthy adults (avoid rapid boluses); maintenance of MAC sedation, most patients require 80% of the usual adult dose (avoid rapid boluses) [4]

Administration:

 

Intravenous
  • if lidocaine is used to reduce pain, administer prior to propofol or add to propofol immediately before administration in quantities not exceeding 20 mg lidocaine/200 mg propofol [4]
  • if dilution is required, use D5W, do not dilute to less than 2 mg/mL [4]
  • flush the IV line every 12 hours and at the end of the anesthetic procedure [4][13][14]
  • tubing and any unused emulsion must be discarded after 12 hours from spiking vial [4][13][14] (including Fresenius Propoven 1% (propofol 1%) formulation) [3]
  • emulsion transferred to a syringe should be done immediately after opening the vial and must be used within 12 hours from transfer [15][13][14] (within 6 hours for Fresenius Propoven 1% (propofol 1%)) [3]
  • filter propofol with caution (use 5 micron or greater pore size); only when clinically appropriate [4]
  • maintain strict aseptic technique during handling because the vehicle is capable of supporting growth of bacteria [4]; Fresenius Propoven 1% (propofol 1%) does not contain antimicrobial retardants [3]
  • never use single-use vials more than once or for more than 1 patient; discard unused portions to avoid transmission of bloodborne pathogens [15]
  • discard tubing and any unused portions after 12 hours from vial spiking when used for general anesthesia/MAC sedation and ICU sedation, including Fresenius Propoven 1% (propofol 1%) formulation [15][3].[13][14]
  • Fresenius Propoven 1% (propofol 1%) formulation is intended only for single-use administration [3]
  • may be used with agents commonly used in anesthesia (eg, atropine, scopolamine, glycopyrrolate, diazepam, depolarizing and nondepolarizing muscle relaxants and opioid analgesics, and with inhalational and regional anesthetic agents) for the maintenance of general anesthesia [15]
  • do not administer as a rapid bolus to elderly, debilitated, or America Society of Anesthesiologists Physical Status (ASA-PS) III or IV patients as this increases risk of cardiorespiratory events [15]

Contraindications:

 

  • allergies to eggs, egg products, soybeans, soy products [15], or peanuts [3]
  • hypersensitivity to propofol or any of its components [15]

Precautions:

 

  • Cardiovascular:
  • — cardiorespiratory effects, including hypotension, may occur, especially after rapid bolus injection in elderly, debilitated, or American Society of Anesthesia classification III/IV patients; monitoring and dosage adjustment recommended for these populations [15]
  • — bradycardia, asystole, and/or cardiac arrest may occur, with increased risk in pediatric patients concomitantly given fentanyl; monitoring recommended [15]
  • — hypotension and cardiovascular depression may occur and are responsive to discontinuation; monitoring recommended [15]
  • Endocrine and Metabolic:
  • –lipid metabolism disorders (eg, diabetic hyperlipemia, pancreatitis, primary hyperlipoproteinemia) [15]
  • — use caution in patients with hyperlipidemia as increases in serum triglycerides or serum turbidity may occur; monitoring recommended [15]
  • — zinc deficiency may occur, especially in patients with burns, diarrhea, or major sepsis; avoid using longer than 5 days [15]
  • — Fresenius Propoven 1% (propofol 1%) formulation contains both medium-chain- and long-chain triglycerides; use caution with administration to patients with fat metabolism disorders, total parenteral nutrition (TPN), or other conditions where lipid emulsions should be used with caution [3]
  • Gastrointestinal:
  • — postoperative pancreatitis has been reported [15]
  • Immunologic:
  • — life-threatening anaphylactic reactions may occur [15]
  • — transmission of bloodborne pathogens including hepatitis B, hepatitis C, and HIV may occur as a result of unsafe injection practices and use of propofol vials on multiple patients [15]
  • — microbial contamination resulting in fever, infection, sepsis, and other life-threatening illness and death has been reported; do not use after suspected contamination or required time limits [15]
  • Neurologic:
  • — postoperative unconsciousness accompanied by increased muscle tone, followed by spontaneous recovery, may occur [15]
  • — seizures may occur during the recovery phrase when administered in epileptic patients [15]
  • — perioperative myoclonia may occur [15]
  • — patients with increased intracranial pressure or impaired cerebral circulation; avoid hypotension as this will reduce cerebral perfusion pressure [15]
  • Psychiatric:
  • — rapid awakening, anxiety, agitation, and resistance to mechanical ventilation may occur with abrupt discontinuation [15]
  • Renal:
  • — renal tubule toxicity has been reported; monitoring recommended for patients at risk for renal impairment [15]
  • Respiratory:
  • — cardiorespiratory effects, including apnea, airway obstruction and/or oxygen desaturation, may occur, especially after rapid bolus injection in elderly, debilitated, or American Society of Anesthesia classification III/IV patients; monitoring and dosage adjustment recommended for these populations [15]
  • — pulmonary edema has been reported [15]
  • Other:
  • — propofol infusion syndrome, including metabolic derangements and organ system failures, may occur; increased risk with decreased oxygen delivery, neurological injury, sepsis, and large-dose infusions (long- and short-term) [15]
  • Concomitant use:
  • — avoid blood or plasma through same IV catheter [15]

Adverse Effects:

Common
  • Dermatologic: Injection site pain (up to 28.5% )
  • Gastrointestinal: Nausea and vomiting (2% to 2.5% )
  • Musculoskeletal: Involuntary movement, Muscle (17%)
Serious
  • Cardiovascular: Bradyarrhythmia (4.8% ), Heart failure (up to 10% ), Hypertension, Peds (8%)
  • Gastrointestinal: Pancreatitis
  • Immunologic: Anaphylaxis (rare )
  • Neurologic: Seizure
  • Renal: Acute renal failure
  • Reproductive: Priapism
  • Respiratory: Apnea, Respiratory acidosis
  • Other: Bacterial septicemia, Propofol adverse reaction, Infusion syndrome

Pregnancy / Lactation:

Pregnancy Category

 

 

Breast Feeding

 

 

 

 

 

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