Propofol is available as 1 or 2% emulsion. The 1% emulsion may be given by intravenous injection or infusion, but the 2% emulsion is for infusion only. Infusions and injections should be prepared using aseptic techniques, see Administration as follows.
Induction of anaesthesia is generally carried out by giving propofol by injection or infusion at a rate of 40 mg every 10 seconds; a rate of 20 mg every 10 seconds may be used in high-risk patients including elderly, neurosurgical, and debilitated patients. Most adults under 55 years of age can be anaesthetised by a dose of 1.5 to 2.5 mg/kg; high-risk patients usually require a dose of 1 to 1.5 mg/kg.
When used for maintenance propofol is infused at a rate of between 4 to 12 mg/kg per hour (or 3 to 6 mg/kg per hour for elderly and debilitated patients); alternatively intermittent bolus injections of 20 to 50 mg may be given; rapid bolus doses should be avoided in high risk patients.
A novel delivery system is also available for the induction and maintenance of anaesthesia in adults. The Diprifusor target-controlled infusion system allows the speed of induction and depth of anaesthesia to be controlled by specifying target blood concentrations of propofol. Initial target concentrations for induction range from 4 to 8 micrograms/mL for patients under 55 years of age; lower initial target concentrations should be used in older and debilitated patients and should be increased gradually thereafter in steps of 0.5 to 1 microgram/mL at intervals of 1 minute to achieve a gradual induction of anaesthesia. Target concentrations for maintenance are 3 to 6 micrograms/mL.
In the UK, children aged 1 month and over may be given propofol for the induction and maintenance of anaesthesia. The dose should be adjusted for weight and age and administered slowly until the onset of anaesthesis. Most children over 8 years require an induction dose of 2.5 mg/kg; younger children may require a higher dose within the range of 2.5 to 4 mg/kg. Doses of 9 to 15 mg/kg per hour by intravenous infusion or intermittent bolus injections are suitable for maintenance.
For sedation in diagnostic and surgical procedures in adults an initial infusion of 6 to 9 mg/kg per hour may be given for 3 to 5 minutes; alternatively 0.5 to 1 mg/kg may be injected over 1 to 5 minutes. An infusion of 1.5 to 4.5 mg/kg per hour may be used for maintenance of sedation. High-risk patients usually require a 20% reduction in the maintenance dose.
For the sedation of ventilated adults propofol can be given by intravenous infusion in a dose of 0.3 to 4 mg/kg per hour. If the duration of sedation is in excess of 3 days, lipid concentrations should be monitored. Propofol is contraindicated for sedation in children aged 16 years or less.
Administration: IV Administration:
Administer by IV infusion or IV injection. For IV infusion, use a controlled-infusion device (pump), preferably a volumetric pump. In patients undergoing magnetic resonance imaging (MRI), use metered controlled devices when mechanical pumps are not suitable.
Use the larger veins of the forearm or antecubital fossa (rather than hand veins) in adults and children to minimize pain at the injection site; may also administer IV lidocaine prior to administration of propofol to minimize pain.
Transfer contents of the vial into a sterile, single-use syringe immediately after cleaning the rubber stopper with 70% isopropyl alcohol; use a sterile venting spike when withdrawing propofol from vials.
Shake well just prior to administration.
Manufacturers state that propofol should not be admixed with other therapeutic agents prior to administration. Do not administer through the same catheter as blood, serum, or plasma.
Sedation in critical care settings: Minimize manipulations of IV lines; start administration promptly and complete within 12 hours after spiking the vial. Discard any unused portion and the IV tubing at the end of the procedure or after 12 hours (within 6 hours if the drug has been transferred prior to administration).
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