Propofol

Question 1

Mechanism of action

Answer 1

• interaction with GABA receptor
• delays dissociation of GABA from receptor- increase Cl- channel opening, Na+ channel blocker
• hyperpolarization of cell membrane

Question 2

Pharmacokinetics

Answer 2

• 95-99% protein bound
• renal elim t1/2- 30-60min
• redistribution for termination of action
• glucoronidation within liver, however CL exceeds hepatic flow, 30% within lungs

Question 3

CV effects

Answer 3

• decrease SBP, MAP, SVR
• no change HR
• profound arterial/venous vasodilation -> decrease preload/afterload

Question 4

Pulmonary effects

Answer 4

• dose dependent resp depression

- reduces airway reflexes/bronchodilation

Question 5

CNS effects

Answer 5

• decrease CBF, ICP, CMRO2, IOP

- ** decrease SBP and CBP -> decreased CPP**

Question 6

Concentration

Answer 6

10mg/ml

Question 7

Induction dose

Answer 7

1.5-2.5 mg/kg IV
Considerations:
-elderly- reduce dose d/t CVD/pre-meds
-peds- 2.5-3.5 mg/kg IV

Question 8

Time to unconsciousness

Answer 8

30-60 sec

Question 9

other induction considerations

Answer 9

• minimal hangover
• decreased PONV and PDNV
• does NOT cause hyperalgesia

Question 10

Continuous infusion

Answer 10

sedation 25-100 mcg/kg/min

GA (TIVA) 100-300 mcg/kg/min

Question 11

Risks

Answer 11

remember- hypnotic, NOT analgesic
allergic rxn- egg yolk lectin
bac formation- discard after 6 hrs

Question 12

Propofol infusion syndrome

Answer 12

• acute refractory bradycardia in peds
• RBBB early sign
• asystole if metabolic acidosis, rhabdo, hyperlipidemia, enlarged/fatty liver
• infusion >4mg/kg for >48hrs

Question 13

Fospropofol

Answer 13

• prodrug
• concentration- 35 mg/ml
• initial dose- 6.5 mg/kg (60-90 kg)
• additional dose- 1.6 mg/kg PRN
• decrease dose 25% if >65 y/o and ASA 3-4
• perianal paresthesia 74%