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Pronunciation
(PROE po fole)
Generic Available (U.S.)
Yes
Brand Names: U.S.
Brand Names: Canada
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Induction of anesthesia in patients ≥3 years of age; maintenance of anesthesia in patients >2 months of age; in adults, for monitored anesthesia care sedation during procedures; sedation in intubated, mechanically-ventilated ICU patients
Use: Unlabeled
Postoperative antiemetic; refractory delirium tremens (case reports)
Pregnancy Risk Factor
B
Pregnancy Considerations
Propofol should only be used in pregnancy if clearly needed. Propofol is not recommended for obstetrics, including cesarean section deliveries. Propofol crosses the placenta and may be associated with neonatal CNS and respiratory depression.
Lactation
Enters breast milk/not recommended
Contraindications
Hypersensitivity to propofol or any component of the formulation; hypersensitivity to eggs, egg products, soybeans, or soy products; when general anesthesia or sedation is contraindicated
Warnings/Precautions
Concerns related to adverse effects:
• Anaphylaxis/hypersensitivity reactions: May rarely cause hypersensitivity, anaphylaxis, anaphylactoid reactions, angioedema, bronchospasm, and erythema; medications for the treatment of hypersensitivity reactions should be available for immediate use.
• Hypertriglyceridemia: Because propofol is formulated within a 10% fat emulsion, hypertriglyceridemia is an expected side effect. Patients who develop hypertriglyceridemia (eg, >500 mg/dL) are at risk of developing pancreatitis. Serum triglyceride levels should be obtained prior to initiation of therapy and every 3-7 days thereafter. Monitoring of serum triglycerides should especially be considered with therapy >48 hours with doses exceeding 50 mcg/kg/minute (Devlin, 2005). An alternative sedative agent should be employed if significant hypertriglyceridemia occurs. Use with caution in patients with preexisting hyperlipidemia as evidenced by increased serum triglyceride levels or serum turbidity.
• Hypotension: The major cardiovascular effect of propofol is hypotension especially if patient is hypovolemic or if bolus dosing is used. Hypotension may be substantial with a reduction in mean arterial pressure occasionally exceeding 30%. Use with caution in patients who are hemodynamically unstable, hypovolemic, or have abnormally low vascular tone (eg, sepsis).
• Injection-site reaction: Transient local pain may occur during I.V. injection; lidocaine 1% solution may be administered prior to administration or may be added to propofol immediately prior to administration to reduce pain associated with injection (see Administration).
• Myoclonus: Perioperative myoclonus (eg, convulsions and opisthotonos) has occurred with administration.
• Propofol-related infusion syndrome (PRIS): PRIS is a serious side effect with a high mortality rate characterized by dysrhythmia (eg, bradycardia or tachycardia), heart failure, hyperkalemia, lipemia, metabolic acidosis, and/or rhabdomyolysis or myoglobinuria with subsequent renal failure. Risk factors include poor oxygen delivery, sepsis, serious cerebral injury, and the administration of high doses of propofol (usually doses >83 mcg/kg/minute or >5 mg/kg/hour for >48 hours), but has also been reported following large dose, short-term infusions during surgical anesthesia. The onset of the syndrome is rapid, occurring within 4 days of initiation. The mechanism of the syndrome has yet to be determined. Alternate sedative therapy should be considered for patients with escalating doses of vasopressors or inotropes, when cardiac failure occurs during high-dose propofol infusion, when metabolic acidosis is observed, or in whom lengthy and/or high-dose sedation is needed (Jacobi, 2002; Corbett, 2008).
Disease-related concerns:
• Cardiovascular disease: Use with caution in patients with severe cardiac disease (ejection fraction <50%) or hypotension; may have more profound adverse cardiovascular responses to propofol.
• Increased intracranial pressure: Use with caution in patients with increased intracranial pressure or impaired cerebral circulation; substantial decreases in mean arterial pressure and subsequent decreases in cerebral perfusion pressure may occur; consider continuous infusion or administer as a slow bolus.
• Infection risk: Propofol vials and prefilled syringes have the potential to support the growth of various microorganisms despite product additives intended to suppress microbial growth. To limit the potential for contamination, strictly adhere to recommendations in product labeling for handling and administering propofol.
• Pancreatitis: Use with caution in patients with preexisting pancreatitis; use of propofol may exacerbate this condition.
• Respiratory disease: Use with caution in patients with respiratory disease.
• Seizure disorder: Use with caution in patients with a history of epilepsy or seizures; seizure may occur during recovery phase
Concurrent drug therapy issues:
• Opiates: Concomitant use may lead to increased sedative or anesthetic effects of propofol, more pronounced decreases in systolic, diastolic, and mean arterial pressures and cardiac output. Lower doses of propofol may be needed. In addition, fentanyl may cause serious bradycardia when used with propofol in pediatric patients. Alfentanil use with propofol has precipitated seizure activity in patients without any history of epilepsy.
Special populations:
• ASA-PS (American Society of Anesthesiologists - Physical Status) 3/4 patients: Use a lower induction dose, a slower maintenance rate of administration, and avoid rapidly delivered boluses in ASA-PS 3/4 patients to reduce the incidence of unwanted cardiorespiratory depressive events.
• Debilitated patients: Use a lower induction dose, a slower maintenance rate of administration, and avoid rapidly delivered boluses in debilitated patients to reduce the incidence of unwanted cardiorespiratory depressive events.
• Elderly: Use a lower induction dose, a slower maintenance rate of administration, and avoid rapidly delivered boluses in the elderly to reduce the incidence of unwanted cardiorespiratory depressive events.
• Pediatrics: Safety and efficacy have not been established in pediatric intensive care unit patients; concurrent use of fentanyl and propofol in pediatric patients may result in bradycardia.
• Pregnancy: Propofol should only be used in pregnancy if clearly needed. Not recommended for use in obstetrics, including cesarean section deliveries.
Dosage form specific issues:
• Benzyl alcohol: Some products may contain benzyl alcohol which has been associated with the "gasping syndrome" in neonates.
• Edetate disodium: Some formulations contain edetate disodium which may lead to decreased zinc levels in patients with prolonged therapy (>5 days) or a predisposition to zinc deficiency (eg, burns, diarrhea, or sepsis). A holiday from propofol infusion should take place after 5 days of therapy to allow for evaluation and necessary replacement of zinc.
• Sulfites: Some formulations may contain sulfites.
Other warnings/precautions:
• Abrupt discontinuation: Avoid abrupt discontinuation prior to weaning or daily wake up assessments. Abrupt discontinuation can result in rapid awakening, anxiety, agitation, and resistance to mechanical ventilation; wean the infusion rate so the patient awakens slowly. Discontinue opioids and paralytic agents prior to weaning. Long-term infusions can result in some tolerance; taper propofol infusions to prevent withdrawal.
• Analgesic supplementation: Propofol lacks analgesic properties; pain management requires specific use of analgesic agents, at effective dosages, propofol must be titrated separately from the analgesic agent.
• Experienced personnel: Use requires careful patient monitoring, should only be used by experienced personnel who are not actively engaged in the procedure or surgery. If used in a nonintubated and/or nonmechanically-ventilated patient, qualified personnel and appropriate equipment for rapid institution of respiratory and/or cardiovascular support must be immediately available. Use to induce moderate (conscious) sedation in patients warrants monitoring equivalent to that seen with deep anesthesia.
Adverse Reactions
>10%:
Cardiovascular: Hypotension (children 17%; adults 3% to 26%)
Central nervous system: Movement (children 17%; adults 3% to 10%)
Local: Injection site burning, stinging, or pain (children 10%; adults 18%)
Respiratory: Apnea lasting 30-60 seconds (children 10%; adults 24%), apnea lasting >60 seconds (children 5%; adults 12%)
1% to 10%:
Cardiovascular: Hypertension (children 8%), arrhythmia (1% to 3%), bradycardia (1% to 3%), cardiac output decreased (1% to 3%; concurrent opioid use increases incidence), tachycardia (1% to 3%)
Dermatologic: Pruritus (1% to 3%), rash (children 5%; adults 1% to 3%)
Endocrine & metabolic: Hypertriglyceridemia (3% to 10%)
Respiratory: Respiratory acidosis during weaning (3% to 10%)
<1%, postmarketing, and/or case reports: Agitation, amblyopia, anaphylaxis, anaphylactoid reaction, anticholinergic syndrome, asystole, atrial arrhythmia, bigeminy, cardiac arrest, chills, cough, dizziness, delirium, discoloration (green [urine, hair, or nailbeds]), extremity pain, fever, flushing, hemorrhage, hypersalivation, hypertonia, hypomagnesemia, hypoxia, infusion site reactions (including pain, swelling, blisters and/or tissue necrosis following accidental extravasation); laryngospasm, leukocytosis, lung function decreased, myalgia, myoclonia (rarely including convulsions and opisthotonos), nausea, pancreatitis, paresthesia, phlebitis, postoperative unconsciousness with or without increase in muscle tone, premature atrial contractions, premature ventricular contractions, pulmonary edema, propofol-related infusion syndrome, rhabdomyolysis, somnolence, syncope, thrombosis, urine cloudy, vision abnormality, wheezing
Metabolism/Transport Effects
Substrate of CYP1A2 (minor), CYP2A6 (minor), CYP2B6 (major), CYP2C19 (minor), CYP2C9 (minor), CYP2D6 (minor), CYP2E1 (minor), CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits CYP1A2 (weak), CYP2C9 (weak), CYP2D6 (weak), CYP2E1 (weak), CYP3A4 (weak)
Drug Interactions
Alfentanil: May enhance the adverse/toxic effect of Propofol. Specifically the development of opisthotonus (severe hyperextension and spasticity resulting in arching or bridging position) and/or grand mal seizures. Risk C: Monitor therapy
ARIPiprazole: CYP3A4 Inhibitors (Weak) may increase the serum concentration of ARIPiprazole. Management: Monitor for increased aripiprazole systemic exposure/affects with concomitant use of a weak CYP3A4 inhibitor. Decrease aripiprazole dose to 25% of the usual dose in patients receiving both a CYP3A4 and a CYP2D6 inhibitor (regardless of potencies). Risk C: Monitor therapy
ARIPiprazole: CYP2D6 Inhibitors (Weak) may increase the serum concentration of ARIPiprazole. Management: Monitor for increased aripiprazole pharmacologic effects. Aripiprazole dose adjustments may or may not be required based on concomitant therapy and/or indication. Consult product labeling for specific recommendations. Risk C: Monitor therapy
Conivaptan: May increase the serum concentration of CYP3A4 Substrates (Low risk). Risk C: Monitor therapy
CYP2B6 Inhibitors (Moderate): May decrease the metabolism of CYP2B6 Substrates. Risk C: Monitor therapy
CYP2B6 Inhibitors (Strong): May decrease the metabolism of CYP2B6 Substrates. Risk D: Consider therapy modification
Cyproterone: May decrease the serum concentration of CYP1A2 Substrates. Risk C: Monitor therapy
Cyproterone: May decrease the serum concentration of CYP2E1 Substrates. Risk C: Monitor therapy
Midazolam: May increase the serum concentration of Propofol. Propofol may increase the serum concentration of Midazolam. Risk C: Monitor therapy
Peginterferon Alfa-2b: May decrease the serum concentration of CYP2D6 Substrates. Risk C: Monitor therapy
Pimozide: CYP3A4 Inhibitors (Weak) may increase the serum concentration of Pimozide. Risk X: Avoid combination
Quazepam: May increase the serum concentration of CYP2B6 Substrates. Risk C: Monitor therapy
Ropivacaine: Propofol may increase the serum concentration of Ropivacaine. Risk C: Monitor therapy
Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Food: Edetate disodium, an ingredient of propofol emulsion, may lead to decreased zinc levels in patients on prolonged therapy (>5 days) or those predisposed to deficiency (burns, diarrhea, and/or major sepsis).
Storage
Store between 4°C to 22°C (40°F to 72°F); refrigeration is not required. Do not freeze. If transferred to a syringe or other container prior to administration, use within 6 hours. If used directly from vial/prefilled syringe, use within 12 hours. Shake well before use. Do not use if there is evidence of separation of phases of emulsion.
Reconstitution
Does not need to be diluted; however, propofol may be further diluted in 5% dextrose in water to a concentration of ≥2 mg/mL and is stable for 8 hours at room temperature.
Compatibility
Stable in D5LR, D51/4NS, D51/2NS, D5W, LR. Do not mix with other therapeutic agents prior to administration.
Y-site administration: Compatible: Acyclovir, alfentanil, aminophylline, ampicillin, aztreonam, bumetanide, buprenorphine, butorphanol, calcium gluconate, carboplatin, cefazolin, cefotaxime, cefotetan, cefoxitin, cefuroxime, chlorpromazine, cimetidine, cisplatin, clindamycin, cyclophosphamide, cyclosporine, cytarabine, dexamethasone sodium phosphate, dexmedetomidine, diphenhydramine, dobutamine, dopamine, doxycycline, droperidol, enalaprilat, ephedrine, epinephrine, esmolol, famotidine, fenoldopam, fluconazole, fluorouracil, furosemide, ganciclovir, glycopyrrolate, granisetron, haloperidol, heparin, hydrocortisone sodium succinate, hydromorphone, hydroxyzine, ifosfamide, imipenem/cilastatin, inamrinone, insulin (regular), isoproterenol, ketamine, labetalol, magnesium sulfate, mannitol, meperidine, milrinone, nafcillin, nalbuphine, naloxone, nitroglycerin, nitroprusside, norepinephrine, paclitaxel, palonosetron, pentobarbital, phenobarbital, piperacillin, potassium chloride, prochlorperazine edisylate, propranolol, ranitidine, scopolamine, sodium bicarbonate, succinylcholine, sufentanil, thiopental, ticarcillin/clavulanate, tigecycline. Incompatible: Amikacin, amphotericin B, calcium chloride, diazepam, doripenem, gentamicin, levofloxacin, methotrexate, methylprednisolone sodium succinate, minocycline, mitoxantrone, pantoprazole, phenytoin, tobramycin. Variable (consult detailed reference): Ascorbic acid, atracurium, atropine, cefepime, ceftazidime, ceftriaxone, ciprofloxacin, cisatracurium, digoxin, doxorubicin, fentanyl, lidocaine, lorazepam, metoclopramide, midazolam, morphine, pancuronium, phenylephrine, telavancin, vancomycin, vecuronium, verapamil.
Compatibility in syringe: Compatible: Ondansetron, thiopental. Incompatible: Ceftriaxone. Variable (consult detailed reference): Pantoprazole.
Note: Manufacturers recommend that propofol not be mixed with any other therapeutic agents prior to administration.
Mechanism of Action
Propofol is a short-acting, lipophilic intravenous general anesthetic. The drug is unrelated to any of the currently used barbiturate, opioid, benzodiazepine, arylcyclohexylamine, or imidazole intravenous anesthetic agents. Propofol causes global CNS depression, presumably through it's agonist actions on GABAA receptors, and perhaps also involving reduced glutamatergic activity through NMDA receptor blockade.
Pharmacodynamics/Kinetics
Onset of action: Anesthetic: Bolus infusion (dose dependent): 9-51 seconds (average 30 seconds)
Duration (dose and rate dependent): 3-10 minutes
Distribution: Vd: 2-10 L/kg; after a 10-day infusion, Vd approaches 60 L/kg; decreased in the elderly
Protein binding: 97% to 99%
Metabolism: Hepatic to water-soluble sulfate and glucuronide conjugates (~50%)
Half-life elimination: Biphasic: Initial: 40 minutes; Terminal: 4-7 hours (after 10-day infusion, may be up to 1-3 days)
Excretion: Urine (~88% as metabolites, 40% as glucuronide metabolite); feces (<2%)
Dosage
Dosage must be individualized based on total body weight and titrated to the desired clinical effect; wait at least 3-5 minutes between dosage adjustments to clinically assess drug effects; smaller doses are required when used with narcotics; the following are general dosing guidelines:
General anesthesia: Note: Increase dose in patients with chronic alcoholism (Fassoulaki, 1993); decrease dose with acutely intoxicated (alcoholic) patients.
Induction: I.V.:
Children (healthy) 3-16 years, ASA-PS 1 or 2: 2.5-3.5 mg/kg over 20-30 seconds; use a lower dose for children ASA-PS 3 or 4
Adults (healthy), ASA-PS 1 or 2, <55 years: 2-2.5 mg/kg (~40 mg every 10 seconds until onset of induction)
Elderly, debilitated, or ASA-PS 3 or 4: 1-1.5 mg/kg (~20 mg every 10 seconds until onset of induction)
Maintenance: I.V. infusion:
Children (healthy) 2 months to 16 years, ASA-PS 1 or 2: 125-300 mcg/kg/minute (or 7.5-18 mg/kg/hour); after 30 minutes, if clinical signs of light anesthesia are absent, decrease the infusion rate. Children ≤5 years may require larger infusion rates compared to older children.
Adults (healthy), ASA-PS 1 or 2, <55 years: Initial: 100-200 mcg/kg/minute (or 6-12 mg/kg/hour) for 10-15 minutes; usual maintenance infusion rate: 50-100 mcg/kg/minute (or 3-6 mg/kg/hour) to optimize recovery time
Elderly, debilitated, ASA-PS 3 or 4: 50-100 mcg/kg/minute (or 3-6 mg/kg/hour)
Maintenance: I.V. intermittent bolus: Adults (healthy), ASA-PS 1 or 2, <55 years: 25-50 mg increments as needed
Monitored anesthesia care sedation:
Adults (healthy), ASA-PS 1 or 2, <55 years: Slow I.V. infusion: 100-150 mcg/kg/minute (or 6-9 mg/kg/hour) for 3-5 minutes or slow injection: 0.5 mg/kg over 3-5 minutes followed by I.V. infusion of 25-75 mcg/kg/minute (or 1.5-4.5 mg/kg/hour) or incremental bolus doses: 10 mg or 20 mg
Elderly, debilitated, or ASA-PS 3 or 4 patients: Use 80% of healthy adult dose
ICU sedation in intubated mechanically-ventilated patients: Avoid rapid bolus injection; individualize dose and titrate to response. Adults: Continuous infusion: Initial: 5 mcg/kg/minute (or 0.3 mg/kg/hour); increase by 5-10 mcg/kg/minute (or 0.3-0.6 mg/kg/hour) every 5-10 minutes until desired sedation level is achieved; usual maintenance (Jacobi, 2002): 5-80 mcg/kg/minute (or 0.3-4.8 mg/kg/hour); reduce dose after adequate sedation established and adjust to response (eg, evaluate frequently to use minimum dose for sedation). Daily interruption with retitration is recommended to minimize prolonged sedative effects (Jacobi, 2002).
Postoperative nausea and vomiting (PONV), rescue therapy (unlabeled use; Gan, 2007; Unlugenc, 2004): Adults: I.V.: 20 mg, may be repeated
Refractory status epilepticus (unlabeled use): Adults: 1-2 mg/kg bolus (optional), then 33-167 mcg/kg/minute (or 2-10 mg/kg/hour) (Claassen, 2002; Kälviäinen, 2007; Meierkord, 2010; Rossetti, 2004); titrate to desired effect (eg, burst suppression on EEG). Note: Doses >83 mcg/kg/minute (or >5 mg/kg/hour) may increase the risk of hypotension and propofol-related infusion syndrome (PRIS) especially if used for >48 hours; consider alternative therapies to avoid the risk of PRIS in longer term propofol infusions.
Dosing adjustment in renal impairment: No dosage adjustment necessary.
Dosing adjustment in hepatic impairment: No dosage adjustment necessary.
Administration: I.V.
Strict aseptic technique must be maintained in handling although a preservative has been added. Do not use if contamination is suspected. Do not administer through the same I.V. catheter with blood or plasma. Tubing and any unused portions of propofol vials should be discarded after 12 hours.
To reduce pain associated with injection, use larger veins of forearm or antecubital fossa; lidocaine I.V. (1 mL of a 1% solution) may also be used prior to administration or it may be added to propofol immediately before administration in a quantity not to exceed 20 mg lidocaine per 200 mg propofol. Do not use filter <5 micron for administration.
Administration: I.V. Detail
pH: 7.0-8.5
Monitoring Parameters
Cardiac monitor, blood pressure, oxygen saturation (during monitored anesthesia care sedation), arterial blood gas (with prolonged infusions). With prolonged infusions (eg, ICU sedation), monitor for metabolic acidosis, hyperkalemia, rhabdomyolysis or elevated CPK, hepatomegaly, and progression of cardiac and renal failure.
ICU sedation: Assess and adjust sedation according to scoring system; assess CNS function daily. Serum triglyceride levels should be obtained prior to initiation of therapy and every 3-7 days thereafter, especially if receiving for >48 hours with doses exceeding 50 mcg/kg/minute (Devlin, 2005); use intravenous port opposite propofol infusion or temporarily suspend infusion and flush port prior to blood draw.
Diprivan®: Monitor zinc levels in patients predisposed to deficiency (burns, diarrhea, major sepsis) or after 5 days of treatment.
Dietary Considerations
Propofol is formulated in an oil-in-water emulsion. If on parenteral nutrition, may need to adjust the amount of lipid infused. Propofol emulsion contains 1.1 kcal/mL. Soybean fat emulsion is used as a vehicle for propofol. Formulations also contain egg phosphatide and glycerol.
Patient Education
This is an anesthetic. Appropriate emotional and sensory support is strongly recommended. Following return of consciousness, do not attempt to change position or rise from bed without assistance. Flu-like symptoms (chills, fever, body aches) have been reported for up to 3 days following receiving medication; contact prescriber if symptoms occur. Report immediately any palpitations, respiratory difficulty, or dizziness.
Cardiovascular Considerations
Hemodynamic effects: The major cardiovascular effect of propofol is hypotension especially if patient is hypovolemic or if bolus dosing is used. Hypotension may be substantial with a reduction in mean arterial pressure occasionally exceeding 30%. Propofol may also exert a direct negative inotropic effect in nonfailing and failing myocardium especially with concurrent opioid use (eg, fentanyl). In mechanically ventilated patients, the degree of negative inotropic effects may be exaggerated if positive pressure ventilation is employed. Use caution in patients with ejection fraction (EF) <50%. Bradycardia may also occur with administration especially with concurrent fentanyl administration.
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause dizziness
Mental Health: Effects on Psychiatric Treatment
Concurrent use with psychotropics may produce additive CNS depression and respiratory depression; monitor and adjust dosages as needed
Nursing: Physical Assessment/Monitoring
Dosage and rate of administration should be individualized and titrated to the desired effect, according to relevant clinical factors, premedication, concomitant medications, age, and general condition of patient. Continuous monitoring of vital signs, cardiac and respiratory status, and level of sedation is mandatory during infusion and until full consciousness is regained. Safety precautions must be maintained until patient is fully alert. Propofol is an anesthetic; pain must be treated with appropriate analgesic agents. Do not discontinue abruptly (may result in rapid awakening associated with anxiety, agitation, and resistance to mechanical ventilation). Titrate infusion rate so patient awakes slowly. After long-term administration, it will take longer for reduction of propofol levels than if propofol is used for short-term anesthesia. Reposition patient and provide appropriate skin care, mouth care, and care of patient's eyes every 2-3 hours while sedated. Provide appropriate emotional and sensory support (auditory and environmental).
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Injection, emulsion: 10 mg/mL (20 mL, 50 mL, 100 mL)
Diprivan®: 10 mg/mL (20 mL, 50 mL, 100 mL) [contains edetate disodium, egg lecithin, soybean oil]
References
Bedforth NM and Lockey DJ, “Raynaud's Syndrome Following Intravenous Induction of Anaesthesia,” Anaesthesia, 1995, 50(3):248-9.
Bennett SN, McNeil MM, Bland LA, et al, “Postoperative Infections Traced to Contamination of an Intravenous Anesthetic, Propofol,” N Engl J Med, 1995, 333(3):147-54.
Burow BK, Johnson ME, and Packer DL, “Metabolic Acidosis Associated With Propofol in the Absence of Other Causative Factors,” Anesthesiology, 2004, 101(1):239-41.
Cawley MJ, Guse TM, Laroia A, et al, “Propofol Withdrawal Syndrome in an Adult Patient With Thermal Injury,” Pharmacotherapy, 2003, 23(7):933-9.
Claassen J, Hirsch LJ, Emerson RG, et al, “Treatment of Refractory Status Epilepticus With Pentobarbital, Propofol, or Midazolam: A Systematic Review,” Epilepsia, 2002, 43(2):146-53.
Corbett SM, Montoya ID, and Moore FA, “Propofol-Related Infusion Syndrome in Intensive Care Patients,” Pharmacotherapy, 2008, 28(2):250-58.
Devlin JW, Lau AK, and Tanios MA, “Propofol-Associated Hypertriglyceridemia and Pancreatitis in the Intensive Care Unit: An Analysis of Frequency and Risk Factors,” Pharmacotherapy, 2005, 25(10):1348-52.
Fassoulaki A, Farinotti R, Servin F, et al, "Chronic Alcoholism Increases the Induction Dose of Propofol in Humans," Anesth Analg, 1993, 77(3):553-6.
Gan TJ, Meyer TA, Apfel CC, et al, “Society for Ambulatory Anesthesia Guidelines for the Management of Postoperative Nausea and Vomiting,”Anesth Analg, 2007, 105(6):1615-28.
Gross J, Bailey P, Connis R, et al, “Practice Guidelines for Sedation and Analgesia by Non-Anesthesiologists. An Updated Report by the American Society of Anesthesiologist Task Force on Sedation and Analgesia by Nonanesthesiologists,” Anesthesiology, 2002, 96(4):1004-17
Jacobi J, Fraser GL, Coursin DB, et al, “Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult,” Crit Care Med, 2002, 30(1):119-41.
Kälviäinen R, “Status Epilepticus Treatment Guidelines,” Epilepsia, 2007, 48(Suppl 8):99-102.
Kotani Y, Shimazawa M, Yoshimura S, et al, “The Experimental and Clinical Pharmacology of Propofol, an Anesthetic Agent with Neuroprotective Properties,” CNS Neurosci Ther, 2008, 14(2):95-106.
Kress JP and Hall JB, “Sedation in the Mechanically Ventilated Patient,” Crit Care Med, 2006, 34 (10):2541-46.
Kress JP, Pohlman AS, O'Connor MF, et al, “Daily Interruption of Sedative Infusions in Critically Ill Patients Undergoing Mechanical Ventilation,” N Engl J Med, 2000, 342(20):1471-7.
Liolios A, Guerit JM, Scholtes JL, et al, “Propofol Infusion Syndrome Associated With Short-term Large-Dose Infusion During Surgical Anesthesia in an Adult,” Anesth Analg, 2005, 100(6):1804-6.
McCowan C and Marik P, “Refractory Delirium Tremens Treated With Propofol: A Case Series,” Crit Care Med, 2000, 28(6):1781-4.
Meierkord H, Boon P, Engelsen B, et al, “EFNS Guideline on the Management of Status Epilepticus in Adults,” Eur J Neurol, 2010, 17(3):348-55.
Rossetti AO, Reichhart MD, Schaller MD, et al, “Propofol Treatment of Refractory Status Epilepticus: A Study of 31 Episodes,” Epilepsia, 2004, 45(7):757-63.
Shapiro BA, Warren J, Egol AB, et al, “Practice Parameters for Intravenous Analgesia and Sedation for Adult Patients in the Intensive Care Unit: An Executive Summary. Society of Critical Care Medicine, Crit Care Med, 1995, 23(9):1596-600.
Short TG and Young Y, “Toxicity of Intravenous Anaesthetics,” Best Pract Res Clin Anaesthesiol, 2003, 17(1):77-89.
Training Committee, American Society for Gastrointestinal Endoscopy, “Training Guideline for Use of Propofol in Gastrointestinal Endoscopy,” Gastrointest Endosc, 2004, 60(2):167-72.
Unlugenc H, Guler T, Gunes Y, et al, “Comparative Study of the Antiemetic Efficacy of Ondansetron, Propofol and Midazolam in the Early Postoperative Period,” Eur J Anaesthesiol, 2004, 21(1):60-5.
International Brand Names
Lexi-Comp.com
Last full review/revision March 2012
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