Propofol

DEA Class;  Rx

Common Brand Names; Diprivan

Documented hypersensitivity, egg allergy, soybean/soy allergy

• Hypotension (peds 17%; adults 3-26%)
• Apnea lasting 30-60 sec (peds 10%; adults 24%)
• Apnea lasting >60 sec (peds 5%; adults 12%)
• Movement (peds 17%; adults 3-10%)
• Injection site burning/stinging/pain (peds 10%; adults 18%)
• Respiratory acidosis during weaning (3-10%)
• Hypertriglyceridemia (3-10%)
• Hypertension (peds 8%)
• Rash (peds 5%; adults 1-3%)
• Pruritus (1-3%)
• Arrhythmia (1-3%)
• Bradycardia (1-3%)
• Cardiac output decreased (1-3%; concurrent opioid use increases incidence)
• Tachycardia (1-3%)
• Arterial hypotension
• Anaphylaxis
• Asystole
• Bronchospasm
• Cardiac arrest
• Seizures
• Opisthotic rxn
• Pancreatitis
• Pulmonary edema
• Phlebitis
• Thrombosis
• Renal tubular toxicity

Drug vehicle (emulsion) is capable of supporting rapid growth of microorganisms; proper aseptic technique is imperative

Closely monitor patients with anemia, hepatic impairment, myxedema, or renal impairment

Risk of potentially fatal propofol infusion syndrome in ICU patients

May cause hypotension, especialy if patient is hypovolemic or if bolus dosing is used; reduction in mean arterial pressure may exceed 30%; use caution in patients who arehemodynamically unstable, hypovelimic, or have abnormally low vascular tone

Use with caution in patients with severe cardiac disease (<50% ejection fraction) or hypotension; may have more profound adverse cardiovascular responses to propofol

Use with caution in patients with increased intracranial pressure or impaired cerebral circulation; mean arterial pressure may decrease substantially; cerebral perfusion may subsequently decrease; consider continuous infusion or administer as a slow bolus

Prefilled syringes may have potential to support growth of various microorganisms dispite additives intended to suppress microbial growth; strictly adhere to recommendations in product labeling for handling and administering propofol

Use caution in patients with respiratory disease and history of epilepsy or seizures; seizures may occur during recovery phase

Propofol lacks analgesic properties; pain management requires specific use of analgesic agents, at effective dosages; titrate propofol separately from analgesic agent

Do not give bolus to ASA III/IV patients; rapid bolus doses will increase cardiorespiratory effects (ie, hypotension, apnea, airway obstruction)

Significant hypertriglyceridemia may be observed during infusion of propofol; 0.1 g lipid (1.1 kcal) per 1 mL propofol

Accidental extravasation may result in tissue necrosis

Risk of chills, fever, body aches

Propofol infusion syndrome may occur; this is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, and cardiac and renal failure (esp with prolonged, high-dose infusions >5 mg/kg/hr for >48 hr)

Pregnancy category: B

Lactation: Excreted in breast milk; effect on nursing infant not known