Propofol

ADMINISTRATION ROUTES:

IV

ALTERNATIVE NAMES:

Fresofol, Diprivan

ICU INDICATIONS:

1. Continuous Sedation
2. Induction of anaesthesia

PRESENTATION AND ADMINISTRATION:

IV:

1% propofol (diprivan) 200 mg in 20 mL and 500 mg in 50 mL

Administer undiluted by bolus or IV infusion.

Compatibility of propofol with the co-administration of blood/serum/ plasma has not been established. When administered using a y-type infusion set, propofol has been shown to be compatible with the following intravenous fluids:

5% dextrose, Hartmanns, 5% dextrose and 0.45% sodium chloride

Store at room temperature.

DOSAGE:

IV:

Continuous Sedation:

1- 20 mL/hr (10 - 200 mg/hr)

Doses > 200 mg/hr should not be used for > 24 hours due to increased risk of Propofol-Related Infusion Syndrome (see WARNINGS)

Induction of anaesthesia:

20- 200 mg given over 30-60 seconds

Critically ill or elderly patients typically require lower doses for induction compared to healthy adults recieving elective anaesthesia

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

Do not use in infants < 1 month old

IV:

Continuous sedation:

1 - 3 mg/kg/hr (max 4 mg/kg/hr) for 48 hrs max

Short term anaesthesia:

2.5 - 3.5 mg/kg over 30 seconds, then 7.5 - 15 mg/kg/hr

CLINICAL PHARMACOLOGY:

Propofol injectable emulsion is an intravenous sedative-hypnotic agent for use in the induction and maintenance of anaesthesia or sedation.

CONTRAINDICATIONS:

1. Known hypersensitivity to propofol

WARNINGS:

Infection risk:

Strict aseptic technique must always be maintained during handling. Propofol injectable emulsion is a single-use parenteral product which contains 0.005% disodium edetate to retard the rate of growth of microorganisms in the event of accidental extrinsic contamination. However, propofol injectable emulsion can still support the growth of microorganisms as it is not an antimicrobially preserved product. Accordingly, strict aseptic technique must still be adhered to. Do not use if contamination is suspected. Discard unused portions as directed within the required time limits. There have been reports in which failure to use aseptic technique when handling propofol injectable emulsion was associated with microbial contamination of the product and with fever, infection/sepsis, other life- threatening illness, and/or death.

Propofol-Related Infusion Syndrome (PRIS):

PRIS is a rare syndrome which can lead to cardiac failure, rhabdomyolysis, metabolic acidosis and renal failure and is often fatal. It usually effects patients undergoing long-term treatment with high doses of propofol. It may or may not be related to green discolouration of urine but should be suspected in patients with progressive acidosis and shock unexplained by another cause. If suspected, propofol should be ceased immediately and an alternative sedative agent used.

PRECAUTIONS:

General:

A lower dose of propofol should be used in patients with haemodynamic instability at time of induction. For patients considered high risk of cardiovascular collapse, consider the use of an alternative agent.

Clinical features of anaphylaxis, which may include angioedema, bronchospasm, erythema, and hypotension, may occur following propofol administration.

Reports of bradycardia, asystole, and rarely, cardiac arrest have been associated with propofol injection..

Laboratory Tests:

No tests in addition to routine ICU tests are required

Drug/Laboratory Test Interactions:

None known

IMPORTANT DRUG INTERACTIONS IN ICU:

Propofol requirements are reduced by concomitant administration of opioids and/or benzodiazepines

ADVERSE REACTIONS:

Body as a Whole:

Propofol-Related Infusion Syndrome

Cardiovascular:

Bradycardia, arrhythmias, ttachycardia, hypotension, decreased cardiac output

Central Nervous System:

Myoclonic jerking (this is not seizure activity)

Metabolic/Nutritional:

Hyperlipidaemia

Injection Site:

Burning/stinging or pain

Respiratory:

Apnoea

Skin and Appendages:

Rash, pruritus