Propofol: Action, Uses, Administration, Side Effect, Nursing Consideration by Nurses Note

  Propofol

Uses of  Propofol

Induction/maintenance of anaesthesia. Continuous sedation in intubated and respiratory-controlled adult pts in ICU. OFF-LABEL: Postop antiemetic, refractory status epilepticus.

CLASSIFICATION

 PHARMACOTHERAPEUTIC: Rapid-acting general anaesthetic. 

CLINICAL: Sedative-hypnotic. 

Precautions of  Propofol

Contraindications: Hypersensitivity to propofol, eggs, egg products, soybean or soy products. 

Cautions: Hemodynamically unstable pts, hypovolemia, severe cardiac/respiratory disease, elevated ICP, impaired cerebral circulation, preexisting pancreatitis, hyperlipidemia, history of epilepsy, seizure disorder, elderly pts, debilitated pts, pts allergic to peanuts.

Action of  Propofol

 Causes CNS depression through agonist action of GABA receptors. Therapeutic Effect: Produces hypnosis rapidly. 

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Pharmacokinetics

 Route IV

Onset  40 sec

Peak N/A

Duration 3–10 min

Rapidly, extensively distributed. Protein binding: 97%–99%. Metabolized in the liver. Primarily excreted in the urine. Unknown if removed by hemodialysis. Rapid awakening can occur 10–15 min after discontinuation. 

Half-life: 3–12 hrs.

Lifespan considerations

 Pregnancy/Lactation: Unknown if drug crosses placenta. Distributed in breast milk. Not recommended for obstetrics, breastfeeding mothers. 

Children: Safety and efficacy not established. FDA-approved for use in pts 2 mos and older. 

Elderly: No age-related precautions noted; lower dosages recommended. 

Interactions of  Propofol

DRUG: Alcohol, CNS depressants (e.g., LORazepam, morphine, zolpidem) may increase CNS, respiratory depression, hypotensive effects. Antihypertensive medications (e.g., amLODIPine, lisinopril, valsartan) may increase hypotensive effects. 

HERBAL: None significant. 

FOOD: None known. 

LAB VALUES: May increase serum triglycerides.

Availability (Rx) of  Propofol

Injection Emulsion: 10 mg/mL.

Administration/handling of  Propofol

IV:  Do not give through same IV line with blood or plasma. 

Reconstitution 

• May give undiluted, or dilute only with D5W. 

• Do not dilute to concentration less than 2 mg/mL (4 mL D5W to 1 mL propofol yields 2 mg/mL).

Rate of Administration of  Propofol

• Too-rapid IV administration may produce marked severe hypotension, respiratory depression, irregular muscular movements.

 • Observe for signs of extravasation (pain, discolored skin patches, white or blue color to peripheral IV site area, delayed onset of drug action). 

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Storage of  Propofol

• Store at room temperature. 

• Discard unused portions. 

• Do not use if emulsion separates.

 • Shake well before using. 

IV incompatibilities of  Propofol

Amikacin (Amikin), amphotericin B complex (Abelcet, AmBisome, Amphotec), bretylium (Bretylol), calcium chloride, ciprofloxacin (Cipro), diazePAM (Valium), digoxin (Lanoxin), DOXOrubicin (Adriamycin), gentamicin (Garamycin), methylPREDNISolone (Solu-Medrol), minocycline (Minocin), phenytoin (Dilantin), tobramycin (Nebcin), verapamil (Isoptin).

IV Compatibilities of  Propofol

Acyclovir (Zovirax), bumetanide (Bumex), calcium gluconate, cefTAZidime (Fortaz), dexmedetomidine (Precedex), DOBUTamine (Dobutrex), DOPamine (Intropin), enalapril (Vasotec), fentaNYL, heparin, insulin, labetalol (Normodyne, Trandate), lidocaine, LORazepam (Ativan), magnesium, milrinone (Primacor), nitroglycerin, norepinephrine (Levophed), potassium chloride, vancomycin (Vancocin). 

Indications/routes/dosage Anesthesia 

IV Infusion: ADULTS, ELDERLY: Induction, 2–2.5 mg/kg (approximately 40 mg q10sec until onset of anesthesia). Maintenance: Initially, 100–200 mcg/kg/min or 6–12 mg/kg/hr for 10–15 min. Usual maintenance infusion: 50– 100 mcg/kg/min or 3–6 mg/kg/hr. CHILDREN 3–16 YRS: Induction, 2.5–3.5 mg/kg over 20–30 sec, then infusion of 125–300 mcg/kg/min or 7.5–18 mg/kg/hr.

Sedation in ICU 

IV Infusion: ADULTS, ELDERLY: Initially, 5 mcg/kg/min (0.3 mg/kg/hr); increase by increments of 5–10 mcg/kg/min (0.3–0.6 mg/kg/hr) q5–10 min until desired sedation level achieved. Usual maintenance: 5–50 mcg/kg/min (0.3–3 mg/kg/hr). Reduce dose after adequate sedation established, and adjust to response. Daily interruption with retitration (sedation vacation) recommended to minimize prolonged sedative effects.

Dosage in Renal/Hepatic Impairment 

No dose adjustment.

Side effects of  Propofol

Frequent: Involuntary muscle movements, apnea (common during induction; often lasts longer than 60 sec), hypotension, nausea, vomiting, IV site burning/stinging. Occasional: Twitching, thrashing, headache, dizziness, bradycardia, hypertension, fever, abdominal cramps, paresthesia, coldness, cough, hiccups, facial flushing, green-tinted urine. Rare: Rash, dry mouth, agitation, confusion, myalgia, thrombophlebitis. 

Adverse effects/toxic reactions of  Propofol

Continuous infusion or repeated intermittent infusions of propofol may result in extreme drowsiness, respiratory depression, circulatory depression, delirium. Too-rapid IV administration may produce severe hypotension, respiratory depression, involuntary muscle movements. Pt may experience acute allergic reaction, characterized by abdominal pain, anxiety, restlessness, dyspnea, erythema, hypotension, pruritus, rhinitis, urticaria. May cause propofol infusion syndrome, a collection of metabolic disorders and organ system failures including metabolic acidosis, hyperkalemia, rhabdomyolysis, hepatomegaly; cardiac, renal failure.

Nursing considerations of  Propofol

Baseline assessment

Resuscitative equipment, suction, O2 must be available. Obtain vital signs before administration. 

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Intervention/evaluation of  Propofol

Observe pt for signs of wakefulness, agitation. Monitor respiratory rate, B/P, heart rate, O2 saturation, ABGs, depth of sedation, serum lipid, triglycerides (if used longer than 24 hrs). May change urine color to green. If continuous highdose infusions do not properly induce sedation, consider additional sedatives (e.g., opioids, hypnotics, benzodiazepines) to achieve desired response.