- Induction of Anaesthesia
PRESENTATION AND ADMINISTRATION:
1% propofol (diprivan) 200mg in 20ml and 500mg in 50ml.
Administer undiluted by bolus or IV infusion
Compatibility of propofol injectable emulsion with the coadministration of blood/serum/ plasma has not been established.
When administered using a y-type infusion set, propofol injectable emulsion has been shown to be compatible with the following intravenous fluids:
5% Dextrose injection, Hartmanns, 5% Dextrose and 0.45% sodium chloride
Store at room temperature
Induction of anaesthesia: doses vary widely in the critically ill (typically 20mg to 200mg)
Sedation: usual doses of 0-20ml/hr; doses of >20ml/hr should not be used for greater than 24 hours due to the risk of propofol infusion syndrome (see WARNINGS)
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
- Dose as in normal renal function
DOSAGE IN PAEDIATRICS:
Sedation in ICU: 1-3mg/kg/hr (max 4mg/kg/hr) IV for no longer than 48 hours.
Short term anaesthesia: child 2.5-3.5mg/kg stat, then 7.5-15mg/kg/hr IV.
- Propofol injectable emulsion is an intravenous sedative-hypnotic agent for use in the induction and maintenance of anaesthesia or sedation.
- known hypersensitivity to propofol
- Strict aseptic technique must always be maintained during handling. Propofol injectable emulsion is a single-use parenteral product which contains 0.005% disodium edetate to retard the rate of growth of microorganisms in the event of accidental extrinsic contamination. However, propofol injectable emulsion can still support the growth of microorganisms as it is not an antimicrobially preserved product under usp standards. Accordingly, strict aseptic technique must still be adhered to. Do not use if contamination is suspected. Discard unused portions as directed within the required time limits. There have been reports in which failure to use aseptic technique when handling propofol injectable emulsion was associated with microbial contamination of the product and with fever, infection/sepsis, other life- threatening illness, and/or death.
- Propofol infusion syndrome is a rare syndrome which can lead to cardiac failure, rhabdomyolysis, metabolic acidosis and renal failure and is often fatal. It usually effects patients undergoing long-term treatment with high doses of propofol.
A lower dose of propofol should be used in patients with haemodynamic instability at the time of induction; consider the use of an alternative agent Clinical features of anaphylaxis, which may include angioedema, bronchospasm, erythema, and hypotension, may occur following propofol injectable emulsion administration
Reports of bradycardia, asystole, and rarely, cardiac arrest have been associated with propofol injectable emulsion.
- Laboratory Tests: No tests in addition to routine ICU tests are required
- Drug/Laboratory Test Interactions: None known
IMPORTANT DRUG INTERACTIONS FOR THE ICU
- Propofol requirements are reduced by concomitant administration of opioids and/or benzodiazepines
- Body as a Whole: Propofol infusion syndrome
- Cardiovascular: Bradycardia; arrhythmia; tachycardia; hypotension; decreased cardiac output
- Central Nervous System: Myoclonic jerking (NOT seizure activity)
- Metabolic/Nutritional: Hyperlipemia
- Injection Site: Burning/stinging or pain.
- Respiratory: Apnea
- Skin and Appendages: Rash, pruritus.