Ex1 Propofol Slides Flashcards
Unconsciousness occurs after
30s
Pain on injection d/t
Small veins, metabisulfite
Advantage of propofol
Awakening after bolus injection is more rapid and complete than with any other induction agent
MOA propofol
Decreased rate of dissociation of GABA from receptor
Increased duration of GABA mediated chloride conductance
Neuronal hyperpolarization
Inhibits ACh in hippocampus/frontal cortex
NMDA inhibition
Induction dose
1.5-2.5 mg/kg IV
Pediatric induction dose
2-3 mg/kg IV
Why do children require larger doses?
Larger central distribution
Why do elderly require lower doses?
Smaller central distribution, Low clearance
Awakening from propofol occurs due to?
Redistribution of drug out of the brain (VRG) to the muscle and fat
Brain concentration of propofol peaks at?
1 minute
Awakening at plasma concentration of?
1-1.5 mcg/ml
Maintenance dosage
100-300 mcg/kg/min
Pediatric maintenance dosage
60-250 mcg/kg/min
Downside of propofol?
No analgesic properties
Compared to volatile agents, how is recovery time?
Modest decrease in recovery time
MAC dose
25-100 mcg/kg/min
Benefit of propofol use
Low incidence of PONV
Effects on CNS
Decreased CMRO2, CBF, ICP
Cerebral auto regulation unaffected
Amnesia similar to midazolam at similar dose
CV effects
Decreased SBP, CO, SVR (>STP)
*destroys sympathetic tone
Decreased preload/myocardial contractility
Propofol is avoided in which types of cases?
EP lab - suppression of SVT
Respiratory effects
Dose dependent depression of ventilation
Decreased VT, RR
Bronchodilation
Decreased vent response to CO2 & hypoxemia
_____% of patients become apneic
30
