PROPOFOL

PROPOFOL (pro'po-fol) Diprivan Classifications: general anesthesia; sedative-hypnotic; Therapeutic: sedative-hypnotic; general anesthesia Prototype: Thiopental Pregnancy Category: B

Availability

10 mg/mL injection

Action

Sedative-hypnotic used in the induction and maintenance of anesthesia or sedation. Rapid onset (40 sec) and minimal excitation during induction of anesthesia.

Therapeutic Effect

Effectively used for conscious sedation.

Uses

Induction or maintenance of anesthesia as part of a balanced anesthesia technique; conscious sedation in mechanically ventilated patients.

Contraindications

Hypersensitivity to propofol or propofol emulsion, which contain soybean oil and egg phosphatide; obstetrical procedures; patients with increased intracranial pressure or impaired cerebral circulation; lactation. Do not use for induction of anesthesia in children <3 y and for maintenance of anesthesia in infants <2 mo.

Cautious Use

Patients with severe cardiac or respiratory disorders or history of epilepsy or seizures; pregnancy (category B).

Route & Dosage

Induction of Anesthesia Adult: IV 2–2.5 mg/kg q10sec until induction onset Adult (>55 y): IV 1–1.5 mg/kg q10sec until induction onset Child (≥3 y): IV 2.5–3.5 mg/kg over 20–30 sec Maintenance of Anesthesia Adult: IV 100–200 mcg/kg/min Adult (>55 y): IV 50–100 mcg/kg/min Child (≥3 y): IV 125–300 mcg/kg/min Conscious Sedation Adult: IV 5 mcg/kg/min for at least 5 min, may increase by 5–10 mcg/kg/min q5–10min until desired level of sedation is achieved (may need maintenance rate of 5–80 mcg/kg/min)

Administration

• Use strict aseptic technique to prepare propofol for injection; drug emulsion supports rapid growth of microorganisms.
• Inspect for particulate matter and discoloration. Discard if either is noted.
• Shake well before use. Inspect for separation of the emulsion. Do not use if there is evidence of separation of phases of the emulsion.

Intravenous PREPARE: IV Infusion: Give undiluted or diluted in D5W to a concentration not less than 2 mg/mL. Begin drug administration immediately after preparation and complete within 6 h.   ADMINISTER: IV Infusion: • Use syringe or volumetric pump to control rate. • Determine rate by weight. • Administer immediately after spiking the vial. Complete infusion within 6 h.  INCOMPATIBILITIES Y-site: Amikacin, amphotericin B, ascorbic acid, atracurium, bretylium, calcium chloride, ciprofloxacin, cisatracurium, diazepam, digoxin, doxorubicin, gentamicin, levofloxacin, methotrexate, methylprednisolone, metoclopramide, minocycline, mitoxantrone, netilmicin, phenytoin, tobramycin, verapamil.

• Store unopened between 4° C (40° F) and 22° C (72° F). Refrigeration is not recommended. Protect from light.

Adverse Effects (≥1%)

CNS: Headache, dizziness, twitching, bucking, jerking, thrashing, clonic/myoclonic movements. Special Senses: Decreased intraocular pressure. CV: Hypotension, ventricular asystole (rare). GI: Vomiting, abdominal cramping. Respiratory: Cough, hiccups, apnea. Other: Pain at injection site.

Diagnostic Test Interference

Propofol produces a temporary reduction in serum cortisol levels. However, propofol does not seem to inhibit adrenal responsiveness to ACTH.

Interactions

Drug: Concurrent continuous infusions of propofol and alfentanil produce higher plasma levels of alfentanil than expected. cns depressants cause additive CNS depression.

Pharmacokinetics

Onset: 9–36 sec. Duration: 6–10 min. Distribution: Highly lipophilic, crosses placenta, excreted in breast milk. Metabolism: Extensively in the liver (CYP 2B6, 2C9). Elimination: Approximately 88% of the dose is recovered in the urine as metabolites. Half-Life: 5–12 h.

Nursing Implications

Assessment & Drug Effects

• Monitor hemodynamic status and assess for dose-related hypotension.
• Take seizure precautions. Tonic-clonic seizures have occurred following general anesthesia with propofol.
• Be alert to the potential for drug induced excitation (e.g., twitching, tremor, hyperclonus) and take appropriate safety measures.
• Provide comfort measures; pain at the injection site is quite common especially when small veins are used.

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Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug