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CNS inhibition of synaptic transmission. Simple molecule (2,6-di-isopropylphenol), high lipid solubility causes unconsciousness in 20s and lasts for 5-10 mins as it can cross blood-brain barrier quickly.

Propofol is associated with rapid recovery without a hangover effect and it is very widely used especially for day-case surgery. There is sometimes pain on intravenous injection and significant extraneous muscle movements may occur.

Side effects: Convulsions, anaphylaxis and delayed recovery from anaesthesia; flushing; transient apnoea during induction; less commonly thrombosis, phlebitis; very rarely pancreatitis, pulmonary oedema, sexual disinhibition, and discoloration of urine; serious and sometimes fatal side-effects reported with prolonged infusion of doses exceeding 5 mg/kg/hour, including metabolic acidosis, rhabdomyolysis, hyperkalaemia, and cardiac failure

Contraindications: As with all anaesthetics Propofol is contra-indicated if the anaesthetist is not confident of being able to maintain the airway. Not to be used for sedation of ventilated children and adolescents under 17 years (risk of potentially fatal effects including metabolic acidosis, cardiac failure, rhabdomyolysis, hyperlipidaemia and hepatomegaly).

Cautions: Pregnancy – may depress neonatal respiration in third trimester.

Interactions: There are no specific interactions of Propofol with any other drug but because it belongs to the category of general anaesthetics all those interactions apply also to Propofol. See table.

Drug

Effect of interaction

ACE Inhibitors

Enhanced Hypotensive effect

Adrenergic Neurone Blockers

Alpha-blockers

Angiotensin-II Receptor Antagonists

Antipsychotics

Beta-blockers

Calcium-channel Blockers

Clonidine

Diazoxide

Diuretics

Hydralazine

Methyldopa

Minoxidil

Moxonidine

Nitrates

Nitroprusside

Verapamil

Antidepressants, Tricyclic

Increased risk of arrhythmias and enhanced hypotensive effect.

Anxiolytics and Hypnotics

Increased sedative effect

Isoniazid

Potentiate hepatotoxicity of isoniazid

MAOIs

Because of hazardous interactions between general anaesthetics and MAOIs , MAOIs should normally be stopped 2 weeks before surgery

Vancomycin

hypersensitivity-like reactions

Monitoring: As with general anaesthetics, can cause apnoea and hypotension, and so monitor vital signs during procedure plus adequate resuscitative facilities must be available. Onset of convulsions can be delayed special caution after day surgery is required. Propofol has been associated with bradycardia, occasionally profound; intravenous administration of an

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