Propofol (Diprivan®) is an injectable general anesthetic. In which cases to use it? Sedation? How long does it work? What are the risks and contraindications?
Definition: what is propofol?
Propofol is a general anesthetic administered only intravenously. It has a rapid onset of action, of the order of 30 seconds. Its mode of action is not fully understood. It would be based on a GABA-A receptor activation (gamma-aminobutyric acid type A) to block the transmission of nerve signals and induce un sedative or even anesthetic effect.
What are the indications for propofol?
Reserved for hospital use, propofol is used in the following indications:
- to induce and maintain general anesthesia in adults and children from 1 month
- For allow sleep before surgery or a diagnostic medical act that requires it (fibroscopy, colonoscopy) in adults and children from 1 month. Local or regional anesthesia may possibly be associated
- For sedation of a patient over 16 years of age on respiratory assistancehospitalized in an intensive care unit
Under what trade names is propofol found?
Propofol-based commercial specialties are:
- Diprivan® 10 mg/mL and 20 mg/mL emulsion for injection in a pre-filled syringe
- Propofol Lipuro® 5 mg/mL, 10 mg/mL and 20 mg/mL in emulsion for injection for infusion
What is the duration of action of propofol?
After the injection of a usual dose of propofol, the action lasts between 4 to 6 minutes. To prolong this duration of action, propofol must be administered in higher doses, by repeated injections or by infusion to deliver the drug continuously in the body.
What are the side effects of propofol?
The most common side effects are pain at the injection site, transient apnea during administration, potentially severe hypotension. When waking up, headache, nausea and vomiting occur frequently. Propofol may also be responsible for respiratory depression, euphoria, heart disease (arrhythmias, heart failure), kidney failure, high potassium levels in the blood. In humans, the drug can cause an abnormally prolonged or even painful erection.
What are the contraindications of propofol?
Propofol is contraindicated in allergy to one of the components of the drug and in particular in patients allergic to soy or peanuts due to the presence of soy oil. In addition, propofol should not be administered in a child under 16 to induce sedation in a hospital intensive care setting. The use of propofol is not contraindicated in pregnancy or breastfeeding. However, it is strongly discouraged and should not be administered to pregnant women only in the absence of available therapeutic alternatives. When administered to a nursing woman, breast-feeding must be interrupted for 24 hours following the injection of the drug. Due to undemonstrated efficacy and absence of toxicity, the Propofol Lipuro® specialty dosed at 5 mg/mL should not be administered to maintain general anesthesia or sedation during surgery or diagnostic medical act in children. Moreover, it is contraindicated in the induction of sedation if performed in intensive care.
Sources:
– Public drug database
-ANSM
– General anesthetics and drugs used in anesthesia: the essential points, Pharmacomédicale.org