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Propofol Extrahepatic Metabolism — FRCA Primary MCQ

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HardPharmacology - Intravenous AnaestheticsPropofol Extrahepatic MetabolismFRCA Primary

A 76-year-old with severe aortic stenosis and hypovolaemia requires emergency induction. Compared with a healthy unpremedicated adult, which propofol strategy is pharmacodynamically most defensible?

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Correct answer: A — Use smaller, slower aliquots titrated to loss of consciousness and haemodynamic response

The best answer is “Use smaller, slower aliquots titrated to loss of consciousness and haemodynamic response”. Older, hypovolaemic and ASA III–IV patients require less propofol and are more susceptible to vasodilatation, myocardial depression and abrupt hypotension. Slow titration allows effect-site equilibration and assessment between aliquots. Low cardiac output does not justify escalating before effect appears; rapid fixed dosing risks overshoot, particularly when coronary perfusion depends on maintaining arterial pressure.

Reference: Propofol 1% emulsion for injection or infusion, UK SmPC: https://www.medicines.org.uk/emc/product/15152/smpc; Royal College of Anaesthetists, Primary FRCA syllabus v2.2: https://www.rcoa.ac.uk/sites/default/files/documents/2026-01/Primary-FRCA-Syllabus.pdf