Propofol (TCI / TIVA)

How it works

Propofol potentiates inhibitory GABA-A receptor signalling in the central nervous system to produce dose-dependent sedation and anaesthesia; TCI uses a pharmacokinetic model to compute and adjust the infusion rate to reach a chosen target blood or effect-site concentration.

Prescribing in practice

• It causes dose-dependent respiratory depression and hypotension and abolishes airway reflexes, so it must only be used by those trained in anaesthesia and airway management with full monitoring and resuscitation equipment.
• Prolonged high-dose infusion, especially in critically ill or paediatric patients, risks propofol infusion syndrome (metabolic acidosis, rhabdomyolysis, cardiac failure), warranting vigilance and limits on duration and rate.
• It is formulated in a lipid emulsion that supports microbial growth and contributes to caloric and lipid load, requires strict aseptic handling, and is cautioned in egg or soya allergy; for TIVA an appropriate model and depth-of-anaesthesia awareness are needed to avoid accidental awareness.

Monitoring

Monitor depth of anaesthesia, oxygenation, ventilation and cardiovascular status continuously, with processed EEG/depth monitoring advised when neuromuscular blockade is co-administered.

Counselling the patient

• This is an anaesthetic given by a precisely controlled drip to keep the patient asleep during surgery.
• Pain on injection into the vein is common and the team can take steps to reduce it.
• Breathing and blood pressure are monitored and supported throughout.

Evidence & guidelines

Propofol TCI/TIVA is well established, and the Association of Anaesthetists guidance on safe TIVA practice recommends depth-of-anaesthesia monitoring to reduce the risk of accidental awareness.