sedative

Propofol

Diprivan

Route: IV
Onset: 30–60 seconds
Duration: Minutes (short-acting — allows rapid awakening)

Mechanism of action

General anesthetic/sedative. Potentiates GABA-A receptor activity → CNS depression. Mechanism not fully understood but primarily GABAergic. Provides sedation, hypnosis, and anticonvulsant properties. Has intrinsic bronchodilatory properties.

Dosing

Adult: ICU sedation: 5–50 mcg/kg/min IV continuous. Procedural: 0.5–1 mg/kg IV bolus

PRIS risk with doses >83 mcg/kg/min for >48 hours

Indications

Sedation for mechanically ventilated patients (ICU)
Induction and maintenance of general anesthesia
Procedural sedation
Status epilepticus (refractory)

Contraindications

Allergy to eggs, egg lecithin, or soybeans (lipid emulsion)
Hypertriglyceridemia (relative)
Children <3 years for ICU sedation (FDA warning — propofol infusion syndrome risk)

Side effects

Hypotension (most common — significant)
Apnea/respiratory depression
Pain on injection (IV)
Propofol Infusion Syndrome (PRIS) — rare but life-threatening
Hypertriglyceridemia
Green-tinged urine (harmless, from phenol metabolites)
Bradycardia

Monitoring parameters

RASS sedation scale (goal usually −2 to 0)
Blood pressure continuously
Respiratory rate / SpO2
Triglycerides (q48h with prolonged use)
Signs of PRIS: metabolic acidosis, rhabdomyolysis, renal failure, cardiac arrhythmias
Lipid count in nutritional calculations (propofol provides 1.1 kcal/mL)

Drug interactions

CNS depressants (additive respiratory depression)
Opioids (additive)
Benzodiazepines (additive)
Warfarin (propofol vehicle has anticoagulant properties — monitor INR)

NBRC high-yield

Short-acting IV sedative — rapid onset/offset, preferred for daily awakening trials
Contraindicated in egg/soy allergy
PRIS: high dose (>83 mcg/kg/min) >48 hr → metabolic acidosis, rhabdomyolysis
Contains 1.1 kcal/mL — account for caloric content
Hypotension is most common side effect
Green urine is harmless

Clinical pearls

Short context-sensitive half-life — allows rapid awakening ('light it up and turn it off')
Preferred for short-term ICU sedation when daily awakening trials are planned
Propofol 10 mg/mL = 1.1 kcal/mL (count as part of caloric intake)
PRIS: fatal metabolic syndrome with prolonged high-dose use; more common in children
Contains lipid emulsion — bacterial growth risk; change tubing every 12 hours
Provides bronchodilation — may be preferred in bronchospastic patients

Mnemonic

Propofol: PROP it up for short sedation — but watch for PRIS with prolonged high doses

All Drugs

NBRC high-yield

Short-acting IV sedative — rapid onset/offset, preferred for daily awakening trials

Contraindicated in egg/soy allergy

PRIS: high dose (>83 mcg/kg/min) >48 hr → metabolic acidosis, rhabdomyolysis

Contains 1.1 kcal/mL — account for caloric content

Hypotension is most common side effect

Green urine is harmless

Clinical pearls

Short context-sensitive half-life — allows rapid awakening ('light it up and turn it off')

Preferred for short-term ICU sedation when daily awakening trials are planned

Propofol 10 mg/mL = 1.1 kcal/mL (count as part of caloric intake)

PRIS: fatal metabolic syndrome with prolonged high-dose use; more common in children

Contains lipid emulsion — bacterial growth risk; change tubing every 12 hours

Provides bronchodilation — may be preferred in bronchospastic patients