Propofol

How it works

Propofol potentiates inhibitory GABA-A receptor activity in the central nervous system, producing rapid loss of consciousness with a swift, clear-headed recovery.

Prescribing in practice

• Propofol causes dose-dependent cardiorespiratory depression including hypotension and apnoea — it must only be given by those trained in anaesthesia and airway management, with full resuscitation and monitoring equipment immediately available.
• Strict asepsis is essential as the lipid emulsion supports microbial growth; pain on injection is common, and prolonged high-dose infusion risks propofol infusion syndrome.
• Use with caution and reduced dosing in the elderly, hypovolaemic or haemodynamically unstable patient, and note the emulsion contains soya and egg-derived constituents.

Monitoring

Continuously monitor depth of anaesthesia, oxygenation, ventilation and haemodynamics, and observe for metabolic acidosis during prolonged infusions.

Counselling the patient

• This is the medicine that sends you off to sleep for your operation, working within seconds.
• You may feel a brief stinging as it goes into the vein.
• Recovery is usually quick and clear-headed.

Evidence & guidelines

Propofol is a standard, extensively validated intravenous induction and maintenance agent in modern anaesthesia.