Dosing & Uses
Dosage Forms & Strengths
injectable solution
- 10mg/mL
Anesthesia
Induction
- <55 years ASA I/II: 40 mg IVP q10sec until onset (2-2.5 mg/kg IV when not premedicated with oral benzodiazepines or intramuscular opioids)
- >55 years or debilitated or ASA III/IV: 20 mg IVP q10sec until onset (1-1.5 mg/kg); do not use rapid bolus because as it will increase likelihood of undesirable cardiorespiratory depression, including hypotension, apnea, airway obstruction, and/or oxygen desaturation
Maintenance
- <55 years ASA I/II: 0.1-0.2 mg/kg/min IV; administered in a variable rate infusion with nitrous oxide 60% to 70% and oxygen provides anesthesia for patients undergoing general surgery; maintenance infusion should immediately follow induction dose to provide satisfactory or continuous anesthesia during induction phase
- Intermittent bolus: Increments of 25-50 mg (2.5-5 mL) may be administered with nitrous oxide in adults undergoing general surgery; administer incremental boluses when changes in vital signs indicate response to surgical stimulation or light anesthesia
- >55 years or debilitated or ASA III/IV: 0.05-0.1 mg/kg/min IV
MAC Sedation
Initiation
- 0.1-0.15 mg/kg/min IV for 3-5 min; titrate to desired clinical effect; monitor respiratory function; administered as slow infusion or slow injection while monitoring cardiorespiratory function
- Slow injection: 0.5 mg/kg administered over 3-5 min; titrate to clinical response
- Elderly: Do not use rapid bolus dose administration; administer over 3-5 min; reduce dose to approximately 80% of usual adult dose according to their condition, response, and changes in vital signs
Maintenance
- Variable rate of infusion method preferable over intermittent bolus dose method
- Variable rate infusion method: 0.025-0.075 mg/kg/min IV during first 10-15 min sedation maintenance; subsequently decrease infusion rates over time to 25 to 50 mcg/kg/min and adjust clinical response; allow approximately 2 min for onset of peak drug effect to titrate to clinical response; titrate downward in absence of clinical signs of light sedation until mild response to stimulation obtained to avoid sedative administration at rates higher than clinically necessary
- Intermittent bolus method: Administer 10-20 mg increments and titrate to desired level of sedation
- Elderly: 0.02-0.06 mg/kg/min IV; do not use rapid bolus dose administration; reduce rate of administration to 80% of usual adult dose according to their condition, response, and changes in vital signs
Postoperative Nausea/Vomiting
20 mg IV; may repeat
ICU Patient
Initiation: 0.005 mg/kg/min IV for at least 5 min; titrate to desired clinical effect; increase by 5-10 mcg/kg/min over 5-10 min intervals until desired sedation level achieved; allow a minimum of 5 min between adjustments for onset of peak effect
For medical ICU patients or patients who recovered from effect of general anesthesia or deep sedation, rate of administration of 50 mcg/kg/min or more may be required to achieve adequate sedation
Maintenance: 0.005-0.05 mg/kg/min IV individualized and titrated to clinical response; (0.005 mg/kg/min increment increase q5min)
Discontinuation: Avoid discontinuation prior to weaning or for daily evaluation of sedation levels; may result in rapid awakening with associated anxiety, agitation, and resistance to mechanical ventilation
Dosage Forms & Strengths
injectable solution
- 10mg/mL
Anesthesia
Induction
- <3 years: Not recommended
- 3-16 years ASA I/II: 2.5-3.5 mg/kg IVP over 20-30 sec when not premedicated or when lightly premedicated with oral benzodiazepines or intramuscular opioids; younger patients may required higher induction doses than older children; lower dosage recommended for children ASA III/IV
Maintenance
- 2 months-16 years ASA I/II: 0.125-0.3 mg/kg/min IV; after 30 min, if clinical signs of light anesthesia are absent, decrease infusion rate; children 5 years or younger may require larger infusion rates compared to older children
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Adverse Effects
>10%
Hypotension (peds 17%; adults 3-26%)
Apnea lasting 30-60 sec (peds 10%; adults 24%)
Apnea lasting >60 sec (peds 5%; adults 12%)
Movement (peds 17%; adults 3-10%)
Injection site burning/stinging/pain (peds 10%; adults 18%)
1-10%
Respiratory acidosis during weaning (3-10%)
Hypertriglyceridemia (3-10%)
Hypertension (peds 8%)
Rash (peds 5%; adults 1-3%)
Pruritus (1-3%)
Arrhythmia (1-3%)
Bradycardia (1-3%)
Cardiac output decreased (1-3%; concurrent opioid use increases incidence)
Tachycardia (1-3%)
<1%
Arterial hypotension
Anaphylaxis
Asystole
Bronchospasm
Cardiac arrest
Seizures
Opisthotic rxn
Pancreatitis
Pulmonary edema
Phlebitis
Thrombosis
Renal tubular toxicity
Warnings
Contraindications
Documented hypersensitivity, egg allergy, soybean/soy allergy
Cautions
Drug vehicle (emulsion) is capable of supporting rapid growth of microorganisms; proper aseptic technique is imperative
Closely monitor patients with anemia, hepatic impairment, myxedema, or renal impairment
Risk of potentially fatal propofol infusion syndrome in ICU patients
May cause hypotension, especialy if patient is hypovolemic or if bolus dosing is used; reduction in mean arterial pressure may exceed 30%; use caution in patients who arehemodynamically unstable, hypovelimic, or have abnormally low vascular tone
Use with caution in patients with severe cardiac disease (<50% ejection fraction) or hypotension; may have more profound adverse cardiovascular responses to propofol
Use with caution in patients with increased intracranial pressure or impaired cerebral circulation; mean arterial pressure may decrease substantially; cerebral perfusion may subsequently decrease; consider continuous infusion or administer as a slow bolus
Prefilled syringes may have potential to support growth of various microorganisms dispite additives intended to suppress microbial growth; strictly adhere to recommendations in product labeling for handling and administering propofol
Use caution in patients with respiratory disease and history of epilepsy or seizures; seizures may occur during recovery phase
Propofol lacks analgesic properties; pain management requires specific use of analgesic agents, at effective dosages; titrate propofol separately from analgesic agent
Do not give bolus to ASA III/IV patients; rapid bolus doses will increase cardiorespiratory effects (ie, hypotension, apnea, airway obstruction)
Significant hypertriglyceridemia may be observed during infusion of propofol; 0.1 g lipid (1.1 kcal) per 1 mL propofol
Accidental extravasation may result in tissue necrosis
Risk of chills, fever, body aches
Propofol infusion syndrome may occur; this is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, and cardiac and renal failure (esp with prolonged, high-dose infusions >5 mg/kg/hr for >48 hr)
Perioperative myoclonus reported with administration
Anxiety, agitation, and resistance to mechanical ventilation may occur with abrupt withdrawal
General anesthetics and sedation drugs in young children and pregnant women
- Brain development
- Prolonged or repeated exposure may result in negative effects on fetal or young children’s brain development
- Caution with use during surgeries or procedures in children younger than 3 yr or in pregnant women during their third trimester
- Assess the risk:benefit ratio in these populations, especially for prolonged procedures (ie, >3 hr) or multiple procedures
Pregnancy & Lactation
Pregnancy category: B
Lactation: Excreted in breast milk; effect on nursing infant not known
Pregnancy Categories
A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.
B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.
C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.
D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.
X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.
NA:Information not available.
Pharmacology
Mechanism of Action
Short-acting, lipophilic sedative/hypnotic; causes global CNS depression, presumably through agonist actions on GABAa receptors
Absorption
Onset: 30-45 sec
Duration: 3-10 min (dose-dependent duration; dissipation is function of drug redistribution from CNS)
Distribution
Protein bound: 97-99%
Metabolism
Metabolized by hepatic conjugation to inactive compound
Elimination
Half-life: 40 min (initial); 24-72 hr (after 10-day infusion)
Excretion: Urine, feces
Administration
IV Incompatibilities
Y-site: Amikacin, amphotericin B, atracurium, bretylium, calcium chloride, ceftazidime (?), ciprofloxacin, cisatracurium, diazepam, digoxin, doxorubicin, gentamicin, levofloxacin, methotrexate, methylprednisolone sodium succinate, metoclopramide, minocycline, mitoxantrone, morphine sulfate (at high conc of morphine, compatible at 1 mg/mL), netilmicin, phenytoin, tobramycin, verapamil
Do not mix with other drugs prior to administration
IV Compatibilities
Solution: D5W, LR, D5/LR, D5/0.45% NaCl, D5/0.2% NaCl
Syringe: ondansetron, thiopental
Y-site (partial list): Acyclovir, buprenorphine, dopamine, dobutamine, epinephrine, fentanyl, furosemide, hydromorphone, ketamine, lidocaine, meperidine, midazolam (?), nitroglycerin, KCl, MgSO4, vecuronium
IV Preparation
Does not need to be diluted (available form: 10 mg/mL); however, may be further diluted in D5W to 2 mg/mL
IV Administration
To reduce pain associated with injection, use larger veins of forearm or antecubital fossa; lidocaine IV (1 mL of a 1% solution) may also be used prior to administration
Do not use filter with <5 micron for administration
Soybean fat emulsion is used as a vehicle for propofol
Strict aseptic technique must be maintained in handling, although a preservative has been added
Do not administer through the same IV catheter with blood or plasma
American College of Critical Care Medicine recommends use of a central vein for administration in an ICU setting
Storage
Store at room temp; refrigeration is not recommended
Protect from light
Do not use if there is evidence of separation of phases of emulsion
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Patient Handout
Formulary
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