Propofol

Question 1

Propofol Chemical Name and Class

Answer 1

2,6 – diisopropylphenol, Class: Hypnotic

Question 2

Propofol Uses (4)

Answer 2

Induction and maintenance of general anesthesia
Monitored anesthesia care
Anticonvulsant
Antiemetic

Question 3

Propofol MOA

Answer 3

Mimics GABA at the receptor, directly activating chloride channels, which hyperpolarizes the postsynaptic membrane

Question 4

Propofol Induction Dose and GA Maintenance Dose

Answer 4

Induction of GA: 1-2.5mg/kg

Maintenance of GA: 25-300 mcg/kg/min IV

Question 5

Propofol Sedation and Antiemetic Dose

Answer 5

Sedation: 25-100 mcg/kg/min

Antiemetic 10-20 mg can repeat every 5-10 minutes, or start infusion of 10 mcg/kg/min

Question 6

Propofol Onset and Duration

Answer 6

Onset after induction dose: 30 seconds

Duration after induction dose: 5 – 15 minutes

Question 7

Propofol Metabolism

Answer 7

Metabolized via hepatic and extrahepatic metabolism (mostly lungs), no active metabolite

Question 8

Propofol Excretion

Answer 8

Kidneys

Question 9

Propofol CNS Side Effects (5)

Answer 9

Rapid onset and emergence
Raises seizure threshold
Reduces cerebral blood flow, CMRO2, ICP and IOP
No analgesia
Myoclonus may occur

Question 10

Propofol Pulmonary Side Effects (5)

Answer 10

Dose dependent respiratory depression
Infusion will decrease TV and increase RR
Decrease reflexes
Shifts CO2 response curve to the right
Bronchodilation

Question 11

Propofol Cardiovascular Side Effects (3)

Answer 11

Decreases BP r/t decrease SNS and vasodilation
Decrease myocardial contractility and SVR
Decrease venous tone - > lower preload

Question 12

Propofol Metabolism and Elimination Side Effects (1)

Answer 12

Propofol has the potential to change urine color (green or cloudy)

Question 13

Propofol Musculoskeletal Side Effects (1)

Answer 13

Does not prolong neuromuscular blockade but can offer adequate intubation conditions

Question 14

Propofol Considerations (5)

Answer 14

There is no evidence that propofol should be avoided in egg or soy allergic patients
Contains sulfates
Painful on injection
Thrombophlebitis
Bacterial infection risk

Question 15

Propofol Metabolic Complication

Answer 15

Propofol Infusion Syndrome

Question 16

Propofol Infusion Syndrome Risk Factors

Answer 16

Risk factors include doses greater than 4 mg/kg/hour, duration greater than 48 hours, critical illness, concurrent catecholamine infusion, steroid administration, and high-fat and low carbohydrate diet

Question 17

Propofol Infusion Syndrome Etiology

Answer 17

Inhibition of oxidative phosphorylation

Question 18

Propofol Infusion Syndrome Symptoms

Answer 18

Symptoms include metabolic acidosis, persistent bradycardia, cardiac failure, fever and severe hepatic and renal disturbances