Generic Name

Propofol

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Classification

FDA Approved Indications

• Induction and maintenance of general anesthesia
• Sedation for mechanically ventilated patients in ICU

Mechanism of Action

Propofol enhances the activity of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) at GABA-A receptors, leading to sedative, hypnotic, and amnesic effects.

Dosage and Administration

Adult: Induction: 2-2.5 mg/kg IV; maintenance infusion typically 25-75 mcg/kg/min

Pediatric: Dose depends on age and procedure, generally 2-3 mg/kg IV for induction and 25-75 mcg/kg/min infusion

Geriatric: Initial dose reduced by approximately 20-30% due to increased sensitivity

Renal Impairment: Use caution, adjust dose as needed, monitor closely

Hepatic Impairment: Use caution, no specific dose adjustment required but monitor for prolonged sedation

Pharmacokinetics

Absorption: Administered IV; does not involve absorption considerations

Distribution: Rapidly distributes into the brain and highly perfused tissues within minutes

Metabolism: Extensively metabolized in the liver via conjugation to inactive metabolites

Excretion: Metabolites excreted primarily in urine

Half Life: Approximately 2-4 hours

Contraindications

• Known hypersensitivity to propofol or component substances

Precautions

• Use with caution in patients with egg, soy, or peanut allergies, although these allergies are not absolute contraindications.
• Increased risk of propofol infusion syndrome with prolonged high-dose infusions
• Monitor for hypotension, respiratory depression, and cardiac depression

Adverse Reactions - Common

• Hypotension (Common)
• Respiratory depression (Common)
• Pain on injection (Common)

Adverse Reactions - Serious

• Propofol infusion syndrome (Rare but serious, includes metabolic acidosis, rhabdomyolysis, cardiac failure)
• Anaphylaxis (Rare)

Drug-Drug Interactions

• CNS depressants (additive sedative effects)
• Vasopressors may have reduced effectiveness

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Explain that sedation may cause dizziness or drowsiness, advise against operating heavy machinery
• Inform about potential side effects like hypotension or respiratory depression
• Report any allergic reactions, chest pain, or unusual symptoms

Special Considerations

Black Box Warnings:

• Propofol infusion syndrome—potentially fatal condition characterized by metabolic acidosis, rhabdomyolysis, cardiac failure

Genetic Factors: No specific genetic considerations widely documented

Lab Test Interference: May alter serum triglyceride and cholesterol measurements in prolonged infusions

Overdose Management

Signs/Symptoms: Deep sedation, respiratory depression, hypotension, cardiac arrhythmias

Treatment: Supportive care, oxygen therapy, vasopressors if needed, mechanical ventilation if indicated; no specific antidote

Storage and Handling

Storage: Store at 20°C to 25°C (68°F to 77°F); protect from light

Stability: Stable up to the expiration date on the packaging