VERIFIED CONTENTAuthor: Maria Konaszczuk, Master of Pharmacy

A very effective sedative agent. In the hands of an experienced anaesthesiologist, propofol is considered safe and is widely used from surgical procedures to diagnostic procedures.

Action of propofol

Propofol is a substance used only in anaesthesiology. The physician uses this measure to bring the patient into a shallow to moderate state of sedation. Sometimes propofol is used as a pre-treatment for the patient prior to general anesthesia.

Propofol is described as a fast and short-acting anesthetic. Its effects can be observed as early as 30 seconds after bolus injection to the patient or after administration of the drug by continuous infusion. The recovery of the patient after administration of propofol is similarly quick.

The exact mechanism of action of this substance is not described in the Summary of Product Characteristics. Its action is probably related to the positive effect on GABAergic transmission in the nervous system. Its action causes depression of the nervous system and, as a result, sedation of the patient.

Sedation is a state in which the patient becomes calmer, sometimes unaware of the doctors' actions during the procedure. Such a situation is extremely useful when the patient feels an increased fear of the procedure. The medical procedure requires that the patient be calm and immobile, so putting the patient into a light sedation is sometimes not only helpful, but also necessary.

Indications for the use of propofol

The product in the form of an emulsion or liquid for infusion is used to introduce and maintain the patient under general anesthesia. This application applies to adult patients and children from 1 month of age.

Sometimes propofol is given as a sedative while the patient is in the intensive care unit while breathing under control. There are contraindications to such use of propofol in patients under 16 years of age.

This drug is very often given to patients in the company of local anesthetics to calm the patient during diagnostic procedures such as colonoscopy or endoscopy. Propofol is not an analgesic and is therefore usually administeredis accompanied by painkillers.

Propofol dosage

The dosage of propofol is always decided by a specialist anaesthesiologist who has appropriately certified knowledge about sedation. The dose of propofol is individualized for each patient and may be changed during the procedure if the doctor deems it necessary.

The degree of sedation of the patient depends on the dose of propofol administered to him, so the doctor must also take into account the effect he wants to achieve when preparing the patient for the procedure.

Definitely elderly people require dose reduction in relation to younger patients. Rather, administration of propofol to such patients by means of a one-time bolus is avoided. Usually, the anesthetist opts for a slow infusion in older people.

If a physician decides to administer propofol as an intravenous infusion, the drug is usually diluted with glucose or saline solution. Boluses are usually administered in a situation when it is necessary to deepen the patient's sedation during the procedure. Boluses are an undiluted single-use form of administration.

The first injection of propofol can be painful for the patient, so lidocaine can be added to the injection to numb the injection site. Some publications mention the use of paracetamol for this purpose.

Contraindications to the use of propofol

Propofol must not be administered to patients who are hypersensitive to this substance or its auxiliary ingredients.

Propofol must not be given to patients under 16 years of age as a sedative in intensive care units.

One of the ingredients of the propofol solution is soybean oil. Therefore, such a solution cannot be administered to patients allergic to peanut or soy.

Warnings and interactions

Propofol is intended to be used only in treatment that is closed by medical specialists. A person not properly trained to administer this drug may cause respiratory and circulatory depression.

When administering this anesthetic to a patient, he althcare professionals must have access to oxygen therapy and be able to perform CPR. The safety data sheet strongly discourages the simultaneous administration of propofol and performing the procedure by one person.

The effect of propofol is undetectable 12 hours after its administration. Nevertheless, the patient should not be alone, go home or drive a car after the procedure during which he was given propofol.

He should also not take other drugs during this timedepressing the nervous system, such as benzodiazepines or opioids. It is strictly forbidden to consume alcohol after administering propofol to the patient.

To avoid bradycardia during long-term propofol infusion, doctors often administer anticholinergic drugs simultaneously.

An increased risk of seizures has been observed when administering propofol to epilepsy patients.

It is not recommended to administer propofol to children under 1 month of age. There are insufficient data on the safety of this preparation in such young children. There is a risk that a small patient will develop cardiac arrest after the administration.

There is a risk of the so-called propofol syndrome. This is an unexplained reaction of the body to long-term administration of high doses of propofol. It is characterized by the occurrence of lactic acidosis, lipemia, and rhabdomyolysis.

In some cases, even cardiovascular collapse may occur. Patients with severe head trauma or children with a respiratory tract infection who receive propofol in the intensive care unit are at increased risk of developing propofol syndrome.

If you suspect a fat overload, you should monitor your lipid levels while administering propofol.

With regard to pharmacological incompatibilities between propofol and other drugs, no such incompatibilities have been reported when propofol was administered with premedication drugs, neuromuscular blocking agents, inhaled anesthetics, and analgesics.

Please note that according to the SPC, the dose of propofol should be reduced when used as adjunct to regional anesthesia.

If a patient is taking rifampicin, special care should be taken when administering propofol to him as severe hypotension may occur.

Propofol is unlikely to be used in obstetrics as it crosses the placenta and can depress the circulation and / or respiration of the newborn. Propofol is not used in pregnant women unless absolutely necessary.

Studies have shown that a small amount of propofol passes into the breast milk of a nursing mother, therefore, for the sake of the child's safety, a woman should stop breastfeeding for 24 hours after taking propofol.

There are indications of addiction to propofol among medical staff. Only this group has access to propofol, as it is used only in inpatient treatment.

Administering it in too high a dose or infused too quickly maycause respiratory or circulatory arrest, therefore only an experienced anaesthesiologist should administer the drug to the patient only in justified cases.

Side effects of propofol

The most common side effects are:

  • hypotension,
  • slight agitation, euphoria,
  • headache during awakening,
  • epileptiform movements,
  • bradycardia,
  • heart rhythm disturbance,
  • nausea on waking,
  • change in urine color,
  • sexual disinhibition,
  • injection site pain.

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