Propofol

Propofol, 2,6-diisopropylphenol, is administered intravenously and nsed in general anesthesia as a short-acting indnction and maintenance agent The drug is formulated as an oil-water emulsion containing 1 % propofol, soybean oil 10 %, glycerol, and egg phospholipid as emulgent. 

Although propofol is generally said to be a remarkably safe dmg, 14 patients were reported to have life-threatening reactions within a few minutes of the administration of propofol, numerous other anaphylactic-like reactions have been reported, and other occasionally observed hypersensitivity reactions include bronchospasm, angioedema, urticaria, and erythematous rash. The overall incidence of anaphylaxis induced by propofol in France is about 1 % and 0.65 % in the Australian survey (Table 7.1). Another survey estimated that 1.2 % of cases of perioperative anaphylactic shock were attributable to propofol. Risk factors for a reaction are said to be a history of previous dmg allergy and the use with atracu-rium, the latter because of possibly enhanced histamine release. 

Prick testing with propofol is said to be unreliable and intradermal testing is recommended. Prick testing is performed with the undiluted propofol formulation (10 mg/ml). For intfadermal testing, the maximum concentration is a 1 in 10 dilution, that is, propofol 1 mg/ml. Testing should start at 1 in 1,000 and proceed up to the 1 in 10 dilution. 

The hydrophobicity of propofol is due to the aromatic phenyl nucleus and the two isopropyl 

7 Drugs and Other Agents Used in Anesthesia and Surgery 

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Propofol Propofol [2078-54-8] Proportional counters Proposition 65 Propoxides Propoxur [114-26-1]... 

Propofol. 2,6-Diisopropylphenol [2078-54-8] propofol, is a newer intravenous anesthetic used for both induction and maintenance... 

Mice lacking the 8 subunit, which is mainly expressed in cerebellum and thalamus, display an attenuation of ssatrighting reflex time following the administration of the neurosteroids, alphaxalone and pregnanolone, while the responses to propofol, etomindate, ketamine and the benzodiazepine midazolam were unaffected. This demonstrates the role of GABAa receptors containing the 8 subunit for neurosteroid action. 

The other method used is infusion of intravenous anaesthetics such as propofol, etomidate (for induction) and the barbiturates such as thiopental and pentobarbital. Investigations into the mechanism of anaesthesia have made use of all these compounds in order to identify a common mode of action linked to likely mechanisms within the CNS. 

Propofol (Diprivan) is used for induction and maintenance of anesthesia. It also may be used for sedation during diagnostic procedures and procedures that use a local anestiietic. This drug also is used for continuous sedation of intubated or respiratory-controlled patients in intensive care units. 

Propofol-Fresenius (Fresenius-Klinik) Propofol-Parke Davis (Parke Davis)... 

Hypnotics. Common hypnotics are thiopental, propofol, midazolam, etomidate, ketamine and inhaled anesthetics. The incidence of hypersensitivity reactions with thiopental is rare. Recently, thiopental was involved in less than 1% of allergic reactions in France [9]. Ever since Cremophor EL, used as a solvent for some non-barbiturate hypnotics, has been avoided, many previously reported hypersensitivity reactions have disappeared. In the last French surveys, reactions to propofol accounted for less than 2.5% of allergic reactions, and reactions to midazolam, etomidate or ketamine appear to be really rare [9]. Finally, no immune-mediated immediate hypersensitivity reaction involving isoflurane, desflurane or sevoflurane has been reported despite their wide use. 

Adequate pain control (i.e., morphine) and sedative use (i.e., propofol, benzodiazepine)... 

Propofol 5-20 mcg/kg/min continuous IV infusion (preferably through a central line)... 

Propofol infusion syndrome has been described and may result in severe metabolic acidosis, cardiac dysrhythmias, cardiovascular collapse, rhabdomyolysis, and death. The risk may be increased with concomitant catecholamine infusions or when the dose exceeds... 

Propofol 5-20 mcg/kg/min continuous IV infusion (in patients who require frequent neurological assessment) Reassess goals daily and titrate/taper dose to desired response (as patients may accumulate the medication or become tolerant)... 

Estrogens, furosemide, hydrochlorothiazide, interferon alfa-2b, isotretinoin, propofol, and protease inhibitors (e.g., indinavir, nelfinavir, ritonavir, and saquinavir)... 

Consider propofol pharmacotherapy, as it agonizes GABA-A receptors and antagonizes NMDA receptors. Phenobarbital can be used as an alternative... 

Consider magnesium 2 g intravenously for over 20 min ° If sedation is required, consider either propofol (preferred)... 

Midazolam, propofol, and pentobarbital infusions can be used for refractory status epilepticus but may require intensive monitoring and supportive care. 

Propofol 1-2 mg/kg Approximately N/A (typically Hypotension, respiratory Requires mechanical... 

Diprivan) 40 mg every 1 0 seconds titrated to EEG) depression intubation high lipid load (increased calories) propofol infusion syndrome... 

The anesthetic agent propofol can be started with loading doses of 1 mg/kg repeated every 3 to 5 minutes until a clinical... 

Pentobarbital is commonly loaded at a dose of 10 to 15 mg/kg over 1 to 2 hours, followed by a continuous infusion of 0.5 to 4 mg/kg per hour. Therapy can be tapered off after 12 to 24 hours of seizure control as evident on the EEG.35 One metaanalysis reported a lower incidence of treatment failure with pentobarbital (3%) when compared to midazolam (21%) or propofol (20%), although the risk of hypotension requiring vasopressor therapy was higher when pentobarbital was used.36 This relative efficacy for pentobarbital must be considered... 

Propofol (Diprivan) Not recommended due to adverse events (e.g., rhabdomyolysis)... 

Claassen J, Hirsch LJ, Emerson RG, et al. Treatment of refractory status epilepticus with pentobarbital, propofol, or midazolam a systemic review. Epilepsia 2002 43 146-153. 

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