"improving intensive care in Scotland"

Propofol

  • Propofol is an intravenous anaesthetic with sedative properties at sub-anaesthetic doses and is used frequently in ICU.

  • Its mechanism of action is still unclear though is thought likely to be through GABA-mediated inhibition within the CNS.

  • Propofol is insoluble in water and is therefore prepared in a lipid emulsion, the energy content of which is 1.1kcal/ml which should be included in daily calorific provision. This is also a rich host for micro-organisms necessitating sterile handling to prevent contamination and infection.

  • Propofol is available in a 1% and 2% preparation and for sedation in adults is run between 1 and 20ml/hr of 1% with titration to a pre-defined end point.

  • Propofol has some very favourable pharmacokinetic and pharmacodynamic properties supporting its use for continuous intravenous sedation.

  • Propofol does have notable side-effects:

    • Respiratory depression and suppression of laryngeal reflexes, requiring caution with its use in patients with unsecured airways.

    • Cardiovascular depression with a negative inotropic and chronotropic effect and a reduction in systemic vascular resistance. Great care must therefore be taken with hypovolaemic or cardiovascularly unstable patients, and inotropes/vasopressors should be to hand if propofol boluses are being administered.

    • Pain when administered peripherally.

    • Hypertriglycerideaemia and Propofol Infusion Syndrome (see below).

  • Other indications for using propofol in ICU are for the treatment of refractory status epilepticus and as part of a treatment regimen for raised intracranial pressure, e.g. in traumatic brain injuries.

Propofol Infusion Syndrome

  • This is a rare condition which you need know little about.

  • It is defined as the occurrence of acute bradycardia resistant to treatment and progressing to asystole associated with prolonged (>48hrs) high dose (>5mg/kg/hr) propofol infusion.

  • Its main importance is to avoid using prolonged high dose infusions of propofol, but rather use alternative agents alone or in combination.

  • Children are particularly susceptible therefore propofol is not used for prolonged sedation in children.

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