Propofol

Diprivan

Alkylphenol IV induction agent / sedative-hypnotic

Potentiates GABA-A chloride conductance. Direct CNS depression with no analgesia.

Indications

•GA induction
•TIVA maintenance
•Procedural sedation
•ICU sedation
•Antiemetic effect at sub-hypnotic doses

Dosing

Context	Adult	Pediatric
Induction	1.5–2.5 mg/kg IV	2.5–3.5 mg/kg IV
TIVA infusion	100–200 mcg/kg/min	150–250 mcg/kg/min
MAC sedation	25–75 mcg/kg/min	—
PONV antiemetic	10–20 mg IV bolus	—

Pharmacokinetics

Onset 30–45 sec. Duration 5–10 min (single bolus, redistribution). Hepatic clearance + extrahepatic. Context-sensitive half-time stays short up to 8 hr.

Hemodynamic effects

↓SVR + ↓preload + mild ↓contractility → ↓BP 20–30%. Blunts baroreceptor reflex; HR rise often absent or minimal.

Respiratory effects

Dose-dependent apnea, blunted CO₂ response. Bronchodilatory.

Side effects

!Injection pain (mitigate: 40 mg lidocaine pretreat or large vein)
!Hypotension (especially elderly, hypovolemic, cardiac patients)
!Propofol Infusion Syndrome (PRIS) at > 4 mg/kg/hr > 48 h: lactic acidosis, rhabdo, cardiac failure
!Allergy: usually formulation excipients (egg lecithin, soy oil) — true egg allergy uncommonly reactive
!Green urine (benign)

Contraindications

×Severe egg/soy/sulfite allergy (formulation-dependent)

Clinical pearls

★Reduce dose 50% in elderly/frail/hypovolemic.
★TIVA target effect-site 3–6 mcg/mL with Schnider model.
★Antiemetic at doses well below sedative — useful for refractory PONV.

Education only — confirm against current package inserts and institutional protocols. Doses assume normal organ function unless otherwise noted.