propofol: clinical use

Prescribing considerations

• Administration must be separate from the diagnostic or surgical procedure and undertaken by appropriately trained staff with immediate airway and resuscitation facilities.
• Use particular caution in older, debilitated, hypovolaemic or cardiorespiratory-compromised patients.
• Propofol has no analgesic activity.
• Consider lipid exposure and clearance during intensive-care or prolonged use; the emulsion can support microbial growth and requires strict asepsis.
• Remain alert for propofol infusion syndrome, particularly in critically ill patients with impaired oxygen delivery, serious neurological injury, sepsis, or concurrent vasoconstrictors, steroids or inotropes.

Contraindications and cautions

• Hypersensitivity to propofol or any formulation excipient.
• The selected product contains soya oil and must not be used in patients hypersensitive to peanut or soya.
• Intensive-care sedation in patients aged 16 years or younger.

Monitoring

• Continuously monitor oxygenation, ventilation and cardiovascular function during anaesthesia or sedation.
• Monitor for hypotension, airway obstruction, apnoea and bradycardia.
• During relevant intensive-care use, assess acid-base status, potassium, lipids, creatine kinase, renal function, liver findings and ECG changes if infusion syndrome is suspected.
• Consider blood-lipid monitoring in patients at risk of fat overload and zinc status during prolonged administration in susceptible patients.

Clinical pharmacology

Propofol positively modulates GABA-A receptor-mediated inhibition. It distributes extensively, is rapidly cleared, is metabolised mainly in the liver to inactive conjugates and is excreted predominantly in urine.

Formulation and product differences

• The selected formulation is a white oil-in-water emulsion containing refined soya-bean oil, purified egg phosphatide and disodium edetate.
• It contains no antimicrobial preservative; opened containers and administration systems are for one patient and unused contents must be discarded.
• Presentations include ampoules, vials and pre-filled syringes; check equipment compatibility and product-specific handling instructions.
• Use only compatible diluents, additives and intravenous-line arrangements specified in the product information.

Injection

Route: Parenteral

Strengths: 10 mg/mL, 20 mg/mL, 1%, 2%