Propofol Droperidol

Several drugs are used intravenously, alone or in combination with other drugs, to achieve an anesthetic state (as components of balanced anesthesia) or to sedate patients in intensive care units who must be mechanically ventilated. These drugs include the following (1) barbiturates (thiopental, methohexital) (2) benzodiazepines (midazolam, diazepam) (3) opioid analgesics (morphine, fentanyl, sufentanil, alfentanil, remifentanil) (4) propofol (5) ketamine and (6) miscellaneous drugs (droperidol, etomidate, dexmedetomidine). Figure 25-2 shows the structures of... 

Propofol in subhypnotic doses is a potent antiemetic. In a double-blind, randomized study, a small dose of propofol (0.5 mg/kg) was compared with droperidol (20 micro-grams/kg) or metoclopramide (0.2 mg/kg) given at the completion of surgery performed in 90 patients under standard anesthesia with thiopental, fentanyl, and sevo-flurane (59). Follow-up was to 24 hours. The incidence of emesis at 24 hours was significantly lower in those who received propofol (10 versus 33% and 40% for droperidol and metoclopramide respectively). 

Fujii Y, Tanaka H, Kobayashi N. Prevention of postoperative nausea and vomiting with antiemetics in patients undergoing middle ear surgery comparison of a small dose of propofol with droperidol or metoclopramide. Arch Otolaryngol Head Neck Surg 2001 127(l) 25-8. 

Preliminary investigations of intramuscular droperidol, nitrous oxide, and intravenous propofol have yielded favorable results in the treatment of acute migraine headache. Future studies may establish a more defined role for these agents in migraine management. 

Also analyzed acebutolol, acepromazine, acetaminophen, acetazolamide, acetophenazine, albuterol, amitriptyline, amobarbital, amoxapine, antipsrrine, atenolol, atropine, azata-dine, baclofen, benzocaine, bromocriptine, brompheniramine, brotizolam, bupivacaine, buspirone, butabarbital, butalbital, caffeine, carbamazepine, cetirizine, chlorqyclizine, chlordiazepoxide, chlormezanone, chloroquine, chlorpheniramine, chlorpromazine, chlorpropamide, chlorprothixene, chlorthalidone, chlorzoxazone, cimetidine, cisapride, clomipramine, clonazepam, clonidine, clozapine, cocaine, codeine, colchicine, qyclizine, (yclo-benzaprine, dantrolene, desipramine, diazepam, diclofenac, diflunisal, diltiazem, diphenhydramine, diphenidol, dipheno late, dipyridamole, disopyramide, dobutamine, doxapram, doxepin, droperidol, encainide, ethidium bromide, ethopropazine, fenoprofen, fentanyl, flavoxate, fluoxetine, fluphenazine, flurazepam, flurbiprofen, fluvoxamine, fii-rosemide, glutethimide, glyburide, guaifenesin, haloperidol, homatropine, hydralazine, hydrochlorothiazide, hydrocodone, hydromorphone, hydro g chloroquine, hydroxyzine, ibuprofen, imipramine, indomethacin, ketoconazole, ketoprofen, ketorolac, labetalol, le-vorphanol, lidocaine, loratadine, lorazepam, lovastatin, loxapine, mazindol, mefenamic acid, meperidine, mephenytoin, mepivacaine, mesoridazine, metaproterenol, methadone, methdilazine, methocarbamol, methotrexate, methotrimeprazine, methoxamine, methyl-dopa, methylphenidate, metoclopramide, metolazone, metoprolol, metronidazole, midazolam, moclobemide, morphine, nadolol, nalbuphine, naloxone, naphazoline, naproxen, nifedipine, nizatidine, norepinephrine, nortriptyline, oxazepam, oxycodone, oxymetazo-line, paroxetine, pemoline, pentazocine, pentobarbital, pentoxifylline, perphenazine, pheniramine, phenobarbital, phenol, phenolphthalein, phentolamine, phenylbutazone, phenyltoloxamine, phenytoin, pimozide, pindolol, piroxicam, pramoxine, prazepam, prazosin, probenecid, procainamide, procaine, prochlorperazine, procyclidine, promazine, promethazine, propafenone, propantheline, propiomazine, propofol, propranolol, protriptyline, quazepam, quinidine, quinine, racemethorphan, ranitidine, remoxipride, risperidone, salicylic acid, scopolamine, secobarbital, sertraline, sotalol, spironolactone, sulfinpyrazone, sulindac, temazepam, terbutaline, terfenadine, tetracaine, theophylline, thiethyl-perazine, thiopental, thioridazine, thiothixene, timolol, tocainide, tolbutamide, tolmetin, trazodone, triamterene, triazolam, trifluoperazine, triflupromazine, trimeprazine, trimethoprim, trimipramine, verapamil, warfarin, xylometazoline, yohimbine, zopiclone... 

Metoclopramide pre-treatment reduces the dosage requirements of propofol and thiopental. Droperidol, but not ondansetron, reduces the dose requirements of thiopentaL... 

In a randomised, placebo-controlled, double-blind study of 60 surgical patients, half of whom were given metoclopramide 150 micrograms/kg 5 minutes before induction, it was found that the induction dose of propofol was reduced by 24% in the group given metoclopramide. Similar results were seen in another study of 21 patients, in which metoclopramide 10 or 15 mg reduced the dose requirements of propofol by 24.5% and 41.2%, respectively. In a randomised, double-blind, placebo-controlled study in 96 women patients, both metoclopramide and droperidol reduced the amount of thiopental needed to induce anaesthesia by about 45%. ... 

Although the evidence is limited these interactions between metoclopramide and thiopental or propofol, and between droperidol and thiopental would appear to be established. Droperidol has not been studied with propofol, but, on the basis of other interactions it would be expected to behave like metoclopramide. When patients are pretreated with either metoclopramide or droperidol, be alert for the need to use less propofol and thiopental to induce anaesthesia. Ondansetron appears not to interact. 

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