This section of the Intravenous Sedation policy addresses, specifically, the use of propofol for sedation. The purposeful use of propofol for anesthesia is addressed in the Policy and Procedures manual of the Department of Anesthesiology.
The pharmacokinetic and phamacodynamic properties of propofol make this agent the most ideal sedative agent available today. Its efficacy has no peer, it is very short acting, and it has highly desirable antiemetic and pro-euphoric side effects. In fact, in many clinical circumstances, the use of alternative agents (e.g. midazolam) is distinctly inferior. However, propofol is highly potent, and causes significant respiratory and hemodynamic depression (including apnea, severe hypotension, and even cardiovascular collapse).
In view of the above, it is clear that the use of propofol for conscious and deep sedation is highly desirable, and beneficial to patients, when circumstances permit (see below). However, its potency and severe respiratory and hemodynamic depression mandate that it be restricted to use by or on the order of clinicians trained in its use, and independently capable of managing the latter severe consequences.
A. Staff restrictions
Propofol is restricted to use by, or on the order of “approved Physicians”. These are defined as:
ii. the administration of propofol to a patient under the direct verbal order of an approved clinician, with a surrogate physician at the bedside, aided by a nurse specifically trained in the administration of deep sedation, or
iii. the administration of propofol to an endotracheallyintubated patient in the ICU, Radiology suite, or Emergency Department, under the direct verbal order of an approved clinician to a surrogate physician at the bedside.
Propofol is most commonly used undiluted, i.e. 10 mg/ml. Dosing is dependent on purpose of use, duration of use, the patient’s medical condition, and other agents used concurrently, per the judgment of the approved clinician. For sedation of adults by infusion, dosing usually ranges 1-6 mg/kg/hr*. For sedation by intermittent boluses, bolus doses usually range from 0.3-0.8 mg/kg*.
*lean body weight