A. Even small boluses (1 2 cc) may cause apnea, especially following a premed.
B. Reduce propofol doses by 40 60% for elderly patients, sick patients, or following a heavy premed.
A. Check repeatedly that the infusion is running. Continuous infusions are prone to equipment problems, such as the clamps left on the line, running out of drug, excessive backpressure in the line, etc. If the infusion stops for more than a few minutes, your patient will awaken during the operation.
B. Propofol is not amnestic, so patients must be kept completely unconsciousness with propofol to prevent intraoperative awareness.
C. Infuse the propofol through a t-piece connected immediately proximal to the IV catheter to minimize dead space.
D. If the infusion rate is not turned down over time the patient will be overdosed.
E. The infusion can be titrated to blood pressure and heart rate.
F. If your patient is too deep, turn off the propofol for a minute or two. (Remember to turn it back on, or your patient will wake up!) If your patient is too light, give a 1 4 cc bolus of propofol, and increase the infusion rate.
G. The infusion rates are intended for adults in the normal weight range (60-80 kg). The infusion rates should be increased for larger patients and decreased for smaller patients.
H. For sedation, start with an infusion only (no bolus) and titrate to level of wakefulness, respiratory rate, etc.
I. Don't turn off the infusion until 5-10 minutes before the operation is finished.
J. Once the infusion is off, be prepared to give 1-2 cc boluses of propofol for signs of light anesthesia. This allows assessment of anesthetic depth, and thus facilitates rapid emergence at the end of surgery.
III. TIVA: A. Anticipate that the blood pressure will drop following the propofol/fentanyl induction. It usually returns promptly with intubation.
B. Reduce the doses 25 50% for elderly, sick, or heavily premedicated patients.