PROPOFOL

PROPOFOL


Introduction:

  • Most frequently used intravenous anesthetic today.
  • Structure: Consists of phenol ring with isopropyl group attached (26 di-isopropylphenol).
  • Metabolized in liver.
  • Significant extrahepatic metabolism also occurs in lungs and excreted via kidney.
Preparations:
  • Oil-based preparation (soybean oil, egg lecithin & glycerol)
  • Solution color: Milky white. 

Precaution:

  • To be used within 6 hrs after opening vial 
  • Due to death from egg lecithin contamination.
  • Egg lecithin – Good medium for bacterial growth.

Recent propofol preparations:

  • Contains disodium edetate or sodium metabisulfite as antimicrobial agent.
  • Prevents contamination issues.
Actions:
  • Decreases intraocular pressure.
  • Reduces BP.
Uses:
  • Intermittent injection or continuous infusion for total i.v. anesthesia (TIVA) when supplemented by fentanyl.
  • Anesthetic of choice for inductionintubation in ICU & malignant hyperthermia patients.
    • Induction dose = 1-2.5 mg/kg iv.
  • Particularly suitable for outpatient surgery (day-care surgery) – 
    • Due to less marked residual impairment & short-acting.
  • Used for both induction & maintenance.
  • Used for LA-induced seizure.
Advantages:
  • Cerebroprotective.
    • Reduce ICT, cerebral metabolism, oxygen consumption & cerebral perfusion.
  • No anticonvulsive action (unlike thiopentone).
  • No muscle relaxant action (like thiopentone).
  • Antiemetic action – 
    • Reduces post-operative nausea & vomiting.
  • Antipruritic action – 
    • Relieves pruritic in cholestasis & spinal opiates.
  • Rapid recovery after anesthesia or sedation even after prolonged infusion.
  • Safe in porphyria (unlike phenobarbitone).
  • Does not trigger malignant hyperpyrexia.
  • No respiratory irritation.
  • Easy airway instrumentation done –
    • Suppressing airway reflex & cause greater degree of laryngeal muscle relaxation.
  • Does not effect corticosteroid synthesis or alter normal response to ACTH stimulation.
  • Accidental intra-arterial injection or extravasation of propofol does not produce adverse reactions.

Adverse effects:

  • Increased life-threatening infections:
    • By decreasing polymorphonuclear leukocyte chemotaxis but not adherence, phagocytosis & killing.
    • (Note: Thiopentone blocks all these)
  • Causes dose-dependent myocardial depression.
  • Causes bradycardia & apnea.
  • Produces muscle twitching & myoclonus.
  • Pain on injection & rarely thrombophlebitis.

Propofol infusion syndrome:

  • Lethal syndrome, associated with propofol infusion for 48hrs or longer.
  • Occurs in childrencritically ill.
  • Due to failure of free fatty acid metabolism & mitochondrial respiratory chain.
  • FeaturesCardiomyopathy with acute cardiac failure, metabolic acidosis, skeletal myopathy, hyperkalemia, hepatomegaly & lipemia.

Exam Important

  • Propofol infusion syndrome occurs due to failure of free fatty acid metabolism & mitochondrial respiratory chain due to propofol infusion for 48hrs or longer.
  • Features of propofol infusion syndrome include cardiomyopathy with acute cardiac failure, metabolic acidosis, skeletal myopathy, hyperkalemia, hepatomegaly & lipemia.
  • Propofol infusion syndrome occurs in children & critically ill patients.
  • Propofol decreases polymorphonuclear leukocyte chemotaxis but not adherence, phagocytosis & killing.
  • Propofol increases life-threatening infections.
  • Propofol causes dose-dependent myocardial depression.
  • Easy airway instrumentation is done with propofol because it suppressing airway reflex & cause greater degree of laryngeal muscle relaxation.
  • Unlike phenobarbitone, propofol is safe in porphyria.
  • Even after prolonged infusion or sedation rapid recovery possible with propofol.
  • Antipruritic action of propofol relieves pruritic in cholestasis & spinal opiates.
  • Antiemetic action of propofol reduces post-operative nausea & vomiting.
  • Propofol is cerebroprotective by reducing ICT, cerebral metabolism, oxygen consumption & cerebral perfusion.
  • When supplemented by fentanyl, intermittent injection or continuous infusion for total i.v. anesthesia (TIVA).

  • Propofol

    is

    particularly suitable for outpatient surgery (day-care surgery).

  • Anesthetic of choice for intubation in ICU & malignant hyperthermia patients is propofol.
  • Propofol is used for both induction & maintenance.
  • Propofol to be used within 6 hrs after opening vial due to egg lecithin contamination causing death.
  • Egg lecithin is a good medium for bacterial growth.
  • Recent propofol preparations contains disodium edetate or sodium metabisulfite as antimicrobial agent preventing contamination issues.
  • Propofol is the most frequently used intravenous anesthetic today.
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