| Name: |
PROPOFOL (DiprivanR) |
| Classification: |
short acting general anesthetic agent
- low doses may be used as sedation of intubated, mechanically ventilated patients
- short action useful for patients where rapid reversal is desired (e.g. neurological injuries)
- may provide some cerebral protection
- can be used in status epilepticus for refractory seizures
- bronchodilator properties may be useful in treating status asthmaticus
|
| Dose: |
- induction of general anesthesia:
- 2-2.5 mg/kg IV administered at a rate of 40 mg q10seconds until induction onset
- maintenance of general anesthesia:
- surgical diagnostic sedation:
- 0.5-1mg/kg over 3-5 minutes, followed by 1.5-4.5 mg/kg/h for continued sedation
- maintenance of ICU sedation:
- 0.3mg/kg/h, increased by increments of 0.3- 5mg/kg/hr q5min until desired level of sedation
- MAXIMUM DOSE 5 mg/kg/hr (.5 cc/kg/hr) (higher doses have been associated with heart failure when administered to neuro patients)
- may administer boluses of 10-20 mg to rapidly increase sedation in patients not prone to hypotension
- may need to decrease dose by 20-30% in elderly, debilitated or hypovolemic patients
|
| Administration: |
- infuse undiluted; if wish to dilute prior to administration, use only D5W and do not dilute to a concentration <2mg/ml
- do not use if evidence of separation of the emulsion
- discard any unused portions
- must change IV tubing and bottles q12h when running as a continuous infusion
- maintain strict aseptic technique during handling as vehicle can support rapid bacterial growth
- should be weaned off to prevent rapid reversal of sedation
|
| Adverse Effects: |
- hypotension
- bradycardia, arrhythmias
- apnea, airway obstruction
- seizures
- cough
- hyperlipidemia
- excitatory phenomena (spontaneous musculoskeletal movements and twitching and jerking of hands, arms, feet or legs)
- headache, dizziness, agitation, anxiety, confusion, hallucinations, disinhibition upon awakening
- nausea, vomiting, abdominal cramping
- may discolour urine green
|
| Contraindications: |
- do not give to patients allergic to soybean oil or egg phosphatide
- Continuous infusion is not recommended for use in children < 18 years of age.
|
| Drug Interactions: |
- propofol + narcotics = may increase propofol effect
- propofol + other sedatives = may increase propofol effect
|
| Monitoring Therapy: |
- HR, ECG
- BP
- level of sedation, anesthesia
- oxygen saturation
|
| CCTC Protocol: |
- May be administered by IV infusion by an approved nurse in CCTC.
- Continuous infusion must be administered via an infusion pump.
|
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