Critical Care Trauma Centre

PROPOFOL (Diprivan)

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: 
    • 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
Administration:
  • infuse undiluted; if wish to dilute prior to administration, use only dextrose 0.5%. 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
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:
  • continuous heart rate and rhythm
  • blood pressure
  • level of sedation
  • continuous oxygen saturation
Adult Critical Care Protocol:
  • 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.
  • Order written to provide sedation during mechanical ventilation should be discontinued when patient is not longer receiving mechanical ventilation support.


Lynne Kelly, Pharmacist, CCTC
Brenda Morgan, Clinical Nurse Specialist, CCTC
Last Update: October 11, 2018