Ver el código de «Propofol»

==General==
*Type: [[Sedative agent]]
*Dosage Forms: 10mg/mL
*Common Trade Names: Diprivan

==Adult Dosing==
===Standard Induction Sedation===
*Induction = 0.5-1 mg/kg IV over 10s, followed by 0.5 mg/kg every 2-3 minutes as needed
*Small incremental doses (10-30 mg) can slowly be administered to effect conscious sedation

===Other===
*Maintenance dose for sedation between 0.1-0.2 mg/kg/min or 25-50 mg IV PRN in healthy patients < 55 years of age
*Antiemetic dosing, 10-20 mg IV or 10 μg/kg/min infusion

===Adjunctive medications===
*Fentanyl or morphine (propofol does not provide analgesia)
*NS for transient hypotension
*[[Lidocaine]] flush (to reduce injection pain)

===[[ICU Sedation]]===
*5-50 mcg/kg/min IV, increase 5 mcg/kg/min q10min
*Avoid prolonged use, especially of high doses, to avoid propofol infusion syndrome (PRIS)
*[[PRIS]] usually associated with >65 mcg/kg/min for >24hrs, and critically ill patients with increased endogenous glucocorticoids and catecholamines
**[[PRIS]]: [[Heart failure]], [[Rhabdomyolysis]], [[metabolic acidosis]], renal failure
*Propofol drip of these high dosages can be seen in post-intubation [[status epilepticus]] (drip 2-10mg/kg/hr)

==Pediatric Dosing==
*Induction (3-16 yo) at 2.5-3.5 mg/kg IV
*[[Procedural sedation]] 1 mg/kg (max 40 mg), then 0.5 mg/kg PRN (max 20 mg)
*Pediatric population especially at risk for [[Propofol infusion syndrome|propofol infusion syndrome (PRIS)]]

==Special Populations==
*[[Drug Ratings in Pregnancy|Pregnancy Rating]]: Drug of choice for induction in pregnancy (only Category B induction agent)
*[[Lactation risk categories|Lactation risk]]:
*Renal Dosing
**Adult
*** No adjustment necessary
**Pediatric
*** No adjustment necessary 
*Hepatic Dosing
**Adult
*** No adjustment necessary
**Pediatric
*** No adjustment necessary

==Contraindications==
*Allergy to class/drug
*Allergy to soy or eggs
*Hypotension
*Aortic stenosis

===Higher Risk===
*Patients >55 years old
*Debilitated patients
*Patients with significant underlying illness (i.e. ASA physical status score III or IV)
**Optimize volume status before administration
**Largest decrease in systemic BP (vasodilation with only small increase in HR) compared with other induction drugs

==Adverse Reactions==
*Respiratory depression
*Transient hypotension
*Pain at injection site (inject lidocaine 20-40mg IV and fentanyl 50 mcg IV first)
*[[Hypertriglyceridemia]] - check TG levels in ICU setting
*Cardiac arrest (patients with significant cardiac disease receiving propofol for induction at highest risk)
*[[Propofol infusion syndrome]] (PRIS)

==Pharmacology==
*Half-life: 40 minutes (initial); 24-72 hr (after 10-day infusion)
*Metabolism: Hepatic
*Excretion: Renal
*Mechanism of Action: GABA agonist
*Rapid onset (90-100 seconds) and short duration (2-8 minute)
*Wake up after induction dose usually 8-10 min

==Comments==
*Seizure-like activity possible during induction, but safe in seizure disorder (most studies actually support anticonvulsant effect)
*Has significant anti-emetic activity
*Associated with static or reduced intracranial pressure in head injured patients requiring [[ICU Sedation]]<ref>McKeage, K. and Perry, C. M. (2003) ‘Propofol’, CNS Drugs, 17(4), pp. 235–272. </ref>


==Indications by Condition==
''The following table is automatically generated from disease/condition pages across WikEM.''

{{#ask:[[Has DrugName::Propofol]]
 |?Has Indication=Indication
 |?Has Dose=Dose
 |?Has Context=Context
 |?Has Route=Route
 |?Has Population=Population
 |format=broadtable
 |headers=plain
 |link=subject
 |sort=Has Indication
 |limit=50
}}

==See Also==
*[[Sedation (Main)]]
*[[Ketofol]]
*[[Propofol infusion syndrome]]

==References==
<references/>
[[Category:Pharmacology]]
[[Category:Critical Care]]