1
Q
Mechanism of action
A
- interaction with GABA receptor
- delays dissociation of GABA from receptor- increase Cl- channel opening, Na+ channel blocker
- hyperpolarization of cell membrane
2
Q
Pharmacokinetics
A
- 95-99% protein bound
- renal elim t1/2- 30-60min
- redistribution for termination of action
- glucoronidation within liver, however CL exceeds hepatic flow, 30% within lungs
3
Q
CV effects
A
- decrease SBP, MAP, SVR
- no change HR
- profound arterial/venous vasodilation -> decrease preload/afterload
4
Q
Pulmonary effects
A
- dose dependent resp depression
- reduces airway reflexes/bronchodilation
5
Q
CNS effects
A
- decrease CBF, ICP, CMRO2, IOP
- ** decrease SBP and CBP -> decreased CPP**
6
Q
Concentration
A
10mg/ml
7
Q
Induction dose
A
1.5-2.5 mg/kg IV
Considerations:
-elderly- reduce dose d/t CVD/pre-meds
-peds- 2.5-3.5 mg/kg IV
8
Q
Time to unconsciousness
A
30-60 sec
9
Q
other induction considerations
A
- minimal hangover
- decreased PONV and PDNV
- does NOT cause hyperalgesia
10
Q
Continuous infusion
A
sedation 25-100 mcg/kg/min
GA (TIVA) 100-300 mcg/kg/min
11
Q
Risks
A
remember- hypnotic, NOT analgesic
allergic rxn- egg yolk lectin
bac formation- discard after 6 hrs
12
Q
Propofol infusion syndrome
A
- acute refractory bradycardia in peds
- RBBB early sign
- asystole if metabolic acidosis, rhabdo, hyperlipidemia, enlarged/fatty liver
- infusion >4mg/kg for >48hrs
13
Q
Fospropofol
A
- prodrug
- concentration- 35 mg/ml
- initial dose- 6.5 mg/kg (60-90 kg)
- additional dose- 1.6 mg/kg PRN
- decrease dose 25% if >65 y/o and ASA 3-4
- perianal paresthesia 74%
