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|Propofol |
Drugs search, click the first letter of a drug name: | A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z | 1 | 2 | 3 | 4 | 5 | 6 | 8 | 9 Home PropofolPronouncation: (PRO-puh-FOLE)Class: General anesthetic Trade Names: Mechanism of ActionPharmacologyProduces sedation/hypnosis rapidly (within 40 sec) and smoothly with minimal excitation; decreases intraocular pressure and systemic vascular resistance; rarely is associated with malignant hyperthermia and histamine release; suppresses cardiac output and respiratory drive. PharmacokineticsAbsorptionRapidly and extensively distributed. Vd is approximately 60 L/kg (10-day infusion), highly lipophilic. Crosses blood brain barrier and placenta; distributes into breast milk. Protein binding is 95% to 99%. MetabolismLiver conjugation to inactive metabolites. Elimination50% of dose is excreted in the kidney (metabolites). Clearance is 23 to 50 mL/kg/min. Terminal t 1/2 is 1 to 3 days (10-day infusion). T 1/2 of rapid distribution is 2 to 4 min. T 1/2 of slower distribution is 30 to 64 min. OnsetRapid onset, usually within 40 sec from start of injection. Duration3 to 5 min (single bolus). Special PopulationsElderlyWith increasing age, the dose requirement decreases because of occurrence of higher peak plasma concentrations. Indications and UsageInduction and maintenance of anesthesia in adults; induction anesthesia in children at least 3 yr; maintenance anesthesia in pediatric patients at least 2 mo; initiation and maintenance of monitored anesthesia care sedation in adults; sedation in intubated or respiratory-controlled adult ICU patients. ContraindicationsSituations in which general anesthesia or sedation are contraindicated. Dosage and AdministrationAnesthesiaAdults under 55 yr IV Induction 40 mg q 10 sec until onset. Usual dose is 2 to 2.5 mg/kg total. For maintenance infusion, titrate to 100 to 200 mcg/kg/min (6 to 12 mg/kg/hr). For maintenance intermittent bolus, use 25 to 50 mg increments, as needed. Elderly, Debilitated, or ASA III/IV(American Society of Anesthesiologists classification of heart disease, cardiac function, angina, and physical status used to assign risk for anesthesia.) IV 20 mg q 10 sec until onset. Usual dose is 1 to 1.5 mg/kg. For maintenance infusion, titrate to 50 to 100 mcg/kg/min (3 to 6 mg/kg/hr). Neurosurgical patientsIV Induction 20 mg q 10 sec until onset. Usual dose is 1 to 2 mg/kg. For maintenance infusion, use 100 to 200 mcg/kg/min (6 to 12 mg/kg/hr). Children at least 3 yrIV Induction 2.5 to 3.5 mg/kg over 20 to 30 sec. For maintenance infusion (at least 2 mo), use 200 to 300 mcg/kg/min immediately following the induction dose, then, after the first 30 min of maintenance, use infusion rates of 125 to 150 mcg/kg/min titrated to achieve the desired clinical effect, are typically needed. SedationAdults under 55 yr IV Initiation 100 to 150 mcg/kg/min (6 to 9 mg/kg/hr) for 3 to 5 min (preferred method) or slow injection of 0.5 mg/kg over 3 to 5 min; follow by maintenance infusion. For maintenance, use 25 to 75 mcg/kg/min (1.5 to 4.5 mg/kg/hr) (preferred method) or incremental bolus doses of 10 to 20 mg. Elderly, Debilitated, or ASA III/IVIV Initiation Same as adults; not as rapid bolus. For maintenance, use 20% reduction of adult dose; avoid rapid bolus doses. ICU SedationAdults IV Initiation 5 mcg/kg/min (0.3 mg/kg/hr) for at least 5 min; increments of 5 to 10 mcg/kg/min (0.2 to 0.6 mg/kg/hr) over 5 to 10 min may be used until desired level of sedation is achieved. For maintenance, use 5 to 50 mcg/kg/min (0.3 to 3 mg/kg/hr) or higher may be required; use minimum dose required for sedation. General Advice
Storage/StabilityStore between 40° and 72°F. Do not freeze. Protect from light. Drug InteractionsCNS depressants (eg, barbiturates, benzodiazepines, narcotics)Increased CNS depression. IncompatibilityFor IV, do not mix with other therapeutic agents prior to administration. Avoid mixing blood or plasma in same IV catheter. Laboratory Test InteractionsNone well documented. Adverse ReactionsCardiovascularMyocardial ischemia; hypotension; bradycardia; decreased cardiac output; hypertension (especially in children). CNSAmorous behavior; movement hypotonia; hallucinations; neuropathy; opisthotonos. DermatologicRash. EENTConjunctival hyperemia; nystagmus. MetabolicHyperlipidemia. RespiratoryApnea; cough; respiratory acidosis during weaning. MiscellaneousAsthenia; burning, stinging, or pain at injection site; fever. PrecautionsPregnancyCategory B . LactationExcreted in breast milk. ChildrenSafety and efficacy not established for induction anesthesia in children under 3 yr or maintenance anesthesia in children under 2 mo. Labor and DeliveryNot recommended for obstetrical anesthesia (neonatal depression). Special Risk PatientsUse lower induction and maintenance doses in elderly, debilitated, and ASA III/IV patients, and monitor continuously for sign of hypotension or bradycardia. Use with caution in patients with lipid metabolism disorders, because propofol is an emulsion. Epileptics may be at risk of convulsions during recovery phase. Avoid significant decreases in mean arterial pressure (and cerebral perfusion) in patients with increased intracranial pressure or impaired cerebral circulation. AnaphylaxisHas occurred rarely; relationship to drug has not been established. OverdosageSymptomsCardiorespiratory and cardiovascular depression. Patient Information
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