Propofol: The Real Story

Posted on 17 Nov 2011 14:10

Most people probably first heard of propofol when reports of Michael Jackson’s untimely death broke. As the shocking circumstances were unraveled and revealed, an unusual drug was reported to be responsible. Propofol became a household word, well, almost, anyway. But, for those who work in healthcare and especially, anesthesiologists, use of this drug really is an everyday occurrence. In fact, most anesthesiologists will probably use this medication in one manner or another on almost every patient.

Propofol falls under the category of a sedative-hypnotic drug. That means that anesthesiologists and other qualified physicians use it to achieve various states of sedation for patients in a hospital or appropriate surgical setting. Like many anesthetic medications, it is not entirely clear how propofol exerts its effects.

Propofol administration always occurs through an intravenous line into a vein, to reach the central circulation and quickly affect the brain. When given slowly or in small doses, sedation without loss of consciousness is possible. Usually, an infusion pump will be employed to maintain constant and consistent dosing of the medication. Since propofol does not have pain-relieving qualities of its own, intravenous pain medications are often used in conjunction with propofol for short, minimally or moderately uncomfortable procedures.

Most often, propofol acts as an induction agent for general anesthesia. General anesthesia, by definition, results in a state of unconsciousness. Propofol, to induce general anesthesia would be given in a larger, single dose pushed slowly from a syringe into the IV line. The dose is calculated based on a person’s weight and is adjusted based on coexisting medical conditions. Anesthesiologists are specifically trained to understand that propofol affects all body systems and thus, has side effects that must be anticipated. Complications result if the drug is not properly used.

Propofol will predictably cause a drop in blood pressure, heart rate and breathing. For this reason, monitoring of vital signs must absolutely be done continuously while propofol is in use and until its effects are cleared from the body. The more and faster the medication is given and the unhealthier a patient is, the more drastic and rapid these changes in vital signs occur. It takes years of training to be able to predict and successfully manage the severity of these side effects. Medications should always be immediately available to treat drops in blood pressure. In addition, there is no specific reversal agent for propofol, so if complications occur, the practitioner should be skilled at supporting the patients breathing until the drug wears off. This requires not only oxygen, but also other equipment and skills to open the airway and maintain respiration. If breathing has stopped completely, which it will with a large enough dose of propofol, mask-assisted delivery of oxygen or even the placement of a breathing tube and assistance from a ventilator should be available until spontaneous respiration returns. The time it will take for this to occur depends on the dose of the drug, the specific metabolism of the patient, other drugs given with the propofol and other factors.

Anyone who is not skilled in these techniques should not be using propofol, even in a hospital setting. It is not approved as a sleep aid nor should it be used in a private residence with inadequate monitoring and rescue equipment. It is a useful and safe medication only when used in the proper setting by appropriately trained professionals.


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