PROPOFOL (Diprivan)

• 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

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: 

• 6-12mg/kg/hour IV

Surgical diagnostic sedation: 

• 0.5-1mg/kg over 3-5 minutes, followed by 1.5-4.5 mg/kg/hour for continued sedation

Maintenance of ICU sedation: 

• 0.3mg/kg/hour, increased by increments of 0.3- 5mg/kg/h our q5min until desired level of sedation and target VAMAAS
• MAXIMUM DOSE 5 mg/kg/hr (higher doses have been associated with propofol syndrome)
• 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

Refractory Status Epilepticus (unlabeled use - risk:benefit must be assessed and reviewed with Neurologist):

• 1 mg/kg; additional 1-2 mg/kg boluses every 3 to 5 minutes until clinical response to a maximum of 10 mg/kg.
• Continuous infusions start at 2-4 mg/kg/hour; if seizure control is not achieved rapidly, another agent should be added.
• Decrease infusion gradually to prevent rebound seizures.

• Infuse undiluted; if there is a need to dilute prior to administration, use only dextrose 5%. 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

For patients who require an air venting filter, use a 1.2 micron (lipid tubing) filter; propofol will plug a 0.2 micron filter

• Do not give to patients allergic to soybean oil or egg phosphatide
• Continuous infusion for greater than 24 hours is not recommended for use in patients < 18 years of age.

Caution: has not analgesic properties; administer concurrent pain relief as required

• Hypotension, myocardial depression
• Bradycardia - treat bradycardia/asystole with atropine
• Arrhythmias, flushing
• Apnea - use only with mechanical ventilation or during conscious procedural sedation​​​​​​​
• Anaphylaxis, anaphylactoid reactions, cough
• Elevated triglycerides
• 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

​​​​​​​​​Propofol Syndrome:

Metabolic Acidosis, elevated lactate, hypotension, cardiogenic shock, hyperkalemia, rhabdomyolysis, lipemia, renal failure, ST changes/arrhythmias.

QTc prolongation and Known Risk of Torsades de Pointes (TdP)

Propofol prolongs QT interval and is clearly associated with a known risk of TdP, even when taken as recommended. 

Propofol should only rarely, if ever, be given to patients with Congenital Long QT Syndrome (CLQTS) becasue the danger is clear. However, when no alternative safe drug is available and the illness is severe, some patients with CLQTS may be treated with propofol by physicians with expertise in the treatment of arrhythmias. 

• propofol + narcotics = may increase propofol effect
• propofol + other sedatives = may increase propofol effect

• Respiratory rate
• Oxygen Saturation
• Blood pressure
• ECG rhythm and ST changes
• Response to sedation
• Delirium screening
• Blood gases
• Lactate
• Triglycerides, cholesterol
• Liver function tests
• Renal function

• May be administered by IV infusion by a nurse in Adult Critical Care
• May be titrated by a nurse in Adult Critical Care.
• Continuous infusions must be administered by infusion device and the pump library must be enabled. 
• Propofol is indicated for continuous sedation during invasive mechanical ventilation, or for short term procedural sedation. Discontinue propofol when patient is no longer mechanically ventilated or at the conclusion of a short- term procedure.