Propofol is an alkylphenol and is chemically unrelated to any other sedative drug. It was originally developed as a surgical anesthetic drug. Its exact mechanism of action is still unknown. Propofol is not soluble in aqueous fluids, and therefore the commercial formulation consists of 1 per cent propofol in an oil-in-water emulsion containing 10 per cent soybean oil, 1.2 per cent egg phosphatide, and 2.25 per cent glycerol. As this formulation may cause local irritation and phlebitis, propofol should be delivered via a central catheter separated from other drugs.

After intra- and extrahepatic glucuronidation and sulfation the inactive metabolites are excreted in the urine. The pharmacokinetics of propofol ( Table 1) are barely changed by hepatic and renal dysfunction. Concomitant use of fentanyl may reduce the volume of distribution and clearance of propofol and therefore reduce the required dose.

Normally, because of its rapid elimination, full recovery to awareness is reached within minutes to a few hours after discontinuation of propofol, even after long-term administration (BeNer. .etal 1988). Propofol plasma concentrations required for adequate sedation are substantially lower than those needed for surgical anesthesia

(about 1.0 pg/ml). These concentrations are achieved with dose rates between 0.3 and 8 mg/kg/h.

The majority of data concerning the side-effects of propofol are derived from its use as an intravenous anesthetic after bolus administration in the operating room and are not necessarily transferable to patients in the ICU. Propofol often causes mild to moderate hypotension, probably due to a decrease in systemic vascular resistance. Severe bradycardia and conduction disturbances are seen sporadically. Although propofol causes marked respiratory depression only in anesthetic doses, it should be used only in patients with mechanical ventilatory support. Data on the effects of propofol on intracranial hemodynamics, particularly in patients with severe head trauma, are limited, but since it might occasionally reduce cerebral perfusion pressure, it should be used with caution in these patients.

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