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Canadian drug name.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Therapeutic: general anesthetics
Pregnancy Category B
Induction of general anesthesia in children
3 yr and adults. Maintenance of bal-
2 mo and adults. Initia-
mechanically ventilated patients in intensive care units (ICUs).
Short-acting hypnotic. Mechanism of action is unknown. Produces amnesia. Has no
Induction and maintenance of anes-
Administered IV only, resulting in complete absorption.
Rapidly and widely distributed. Crosses the blood-brain barrier
well; rapidly redistributed to other tissues. Crosses the placenta and enters breast
Rapidly metabolized by the liver.
3– 12 hr (blood-brain equilibration half-life 2.9 min).
TIME/ACTION PROFILE (loss of consciousness)
Hypersensitivity to propofol, soybean oil, egg lecithin, or
glycerol; OB: Crosses placenta; may cause neonatal depression; Lactation: Enters
breast milk; effects on newborn unknown.
Cardiovascular disease; Lipid disorders (emulsion may have
detrimental effect); q intracranial pressure; Cerebrovascular disorders; Hypovo-
lemic patients (lower induction and maintenance dosage reduction recommended);
Not recommended for induction of anesthesia in children
3 yr, or for mainte-
2 mo ; not for ICU or pre-procedure sedation; Geri:
bradycardia, hypotension, hy-
abdominal cramping, hiccups, nausea, vomiting.
burning, pain, stinging, coldness, numbness, tingling at IV site.
discoloration of urine
PROPOFOL INFUSION SYNDROME
Additive CNS and respiratory depression with alcohol, antihista-
Serious bradycardia can occur with concurrent use of fentanyl in children.qrisk of
hypertriglyceridemia with intravenous fat emulsion.
55 yr): Induction— 40 mg q 10 sec until induction achieved (2– 2.5
mg/kg total). Maintenance— 100– 200 mcg/kg/min. Rates of 150– 200 mcg/kg/
min are usually required during ﬁrst 10– 15 min after induction, thenpby 30– 50%
during ﬁrst 30 min of maintenance. Rates of 50– 100 mcg/kg/min are associated with
optimal recovery time. May also be given intermittently in increments of 25– 50 mg.
kg total). Maintenance— 50– 100 mcg/kg/min (dose in cardiac anesthesia ranges
from 50– 150 mcg/kg/min depending on concurrent use of opioid).
IV (Adults Undergoing Neurosurgical Procedures): Induction— 20 mg q 10
sec until induction achieved (1– 2 mg/kg total). Maintenance— 100– 200 mcg/kg/
3 yr– 16 yr): Induction— 2.5– 3.5 mg/kg, use lower dose for
children ASA III or IV.
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᭧ 2015 F.A. Davis Company
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ﬁrst 30 min of maintenance, rate should bepif possible), younger children may re-
quire larger infusion rates compared to older children.
Monitored Anesthesia Care (MAC) Sedation
55 yr): Initiation— 100– 150 mcg/kg/min infusion or 0.5 mg/kg as
slow injection. Maintenance— 25– 75 mcg/kg/min infusion or incremental bol-
uses of 10– 20 mg.
usual adult infusion dose; rapid/repeated bolus dosing should be avoided.
mcg/kg/min over 5– 10 min may be given until desired response is obtained. (Range
5– 50 mcg/kg/min”) Dose should be reassessed every 24 hr.
● Assess respiratory status, pulse, and BP continuously throughout propo-
60 sec. Maintain patent
● Assess level of sedation and level of consciousness throughout and following ad-
● When using for ICU sedation, wake-up and assessment of CNS function should be
done daily during maintenance to determine minimum dose required for seda-
tion. Maintain a light level of sedation during these assessments; do not discon-
tinue. Abrupt discontinuation may cause rapid awakening with anxiety, agitation,
and resistance to mechanical ventilation.
● Monitor for propofol infusion syndrome (severe metabolic acidosis, hy-
perkalemia, lipemia, rhabdomyolysis, hepatomegaly, cardiac and renal
failure). Most frequent with prolonged, high-dose infusions (
48 hr) but has also been reported following large-dose, short-
● Toxicity and Overdose: If overdose occurs, monitor pulse, respiration,and BP
continuously. Maintain patent airway and assist ventilation as needed. If hypoten-
sion occurs, treatment includes IV ﬂuids, repositioning, and vasopressors.
Ineffective breathing pattern (Adverse Reactions)
Risk for injury (Side Effects)
● Do not confuse Diprivan (propofol) with Diﬂucan (ﬂuconazole) or Di-
● Dose is titrated to patient response.
● Propofol has no effect on the pain threshold. Adequate analgesia should always be
used when propofol is used as an adjunct to surgical procedures.
● pH: 7.0–8.5.
● Direct IV: Diluent: Usually administered undiluted. If dilution is necessary, use
only D5W. Shake well before use. Solution is opaque, making detection of contam-
inants difﬁcult. Do not use if separation of the emulsion is evident. Contains no
preservatives; maintain sterile technique and administer immediately after prep-
aration. Concentration: Undiluted: 10 mg/mL. If dilution is necessary, dilute to
6 hr. For ICU sedation, discard after 12 hr if administered directly from vial or
after 6 hr if transferred to a syringe or other container. Do not administer via ﬁlter
5– micron pore size.
taminants. Infections and subsequent deaths have been reported. Rate: Admin-
ister over 3– 5 min. Titrate to desired level of sedation. Frequently causes pain,
burning, and stinging at injection site; use larger veins of the forearm, antecubital
fossa, or a dedicated IV catheter. Lidocaine 10– 20 mg IV may be administered
prior to injection to minimize pain. Pedi: Induction doses may be administered
over 20– 30 seconds.
● Intermittent/Continuous Infusion: Diluent: Administer undiluted. Allow 3
to 5 minutes between dose adjustments to allow for and assess the clinical effects.
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10 mg/mL. Rate: Based on patient’s weight (see Route/Dosage
● Solution Compatibility: D5W, LR, D5/LR, D5/0.45% NaCl, D5/0.2% NaCl.
● Y-Site Compatibility: acyclovir, alfentanil, aminophylline, ampicillin, az-
treonam, bumetanide, buprenorphine, butorphanol, calcium gluconate, carbo-
platin, cefazolin, cefepime, cefotaxime, cefoxitin, ceftriaxone, cefuroxime, chlor-
promazine, cisplatin, clindamycin, cyclophosphamide, cyclosporine, cytarabine,
dexamethasone, dexmedetomidine, diphenhydramine, dobutamine, dopamine,
doxycycline, droperidol, enalaprilat, epinephrine, esmolol, famotidine, fenoldo-
pam, fentanyl, ﬂuconazole, ﬂuorouracil, furosemide, ganciclovir, glycopyrrolate,
granisetron, haloperidol, heparin, hydrocortisone sodium succinate, hydromor-
phone, ifosfamide, imipenem/cilastatin, insulin, isoproterenol, ketamine, labeta-
lol, levorphanol, lidocaine, lorazepam, magnesium sulfate, mannitol, meperidine,
milrinone, nafcillin, nalbuphine, naloxone, nitroglycerin, nitroprusside, norepi-
nephrine, paclitaxel, pentobarbital, phenobarbital, potassium chloride, prochlor-
perazine, propranolol, ranitidine, scopolamine, sodium bicarbonate, succinyl-
choline, sufentanil, thiopental, ticarcillin/clavulanate, vecuronium.
● Y-Site Incompatibility: amikacin, amphotericin B colloidal, calcium chloride,
ciproﬂoxacin, diazepam, digoxin, doripenem, doxorubicin, gentamicin, levoﬂox-
acin, methotrexate, methylpredisolone sodium succinate, metoclopramide, mi-
toxantrone, phenytoin, tobramycin, verapamil.
● Inform patient that this medication will decrease mental recall of the procedure.
● May cause drowsiness or dizziness. Advise patient to request assistance prior to
ambulation and transfer and to avoid driving or other activities requiring alertness
for 24 hr following administration.
● Advise patient to avoid alcohol or other CNS depressants without the advice of a
health care professional for 24 hr following administration.
● Induction and maintenance of anesthesia.
● Sedation in mechanically ventilated patients in an intensive care setting.