- Induction and maintenance of anesthesia
ED Specific Indication:
- Procedural sedation performed in the ED
PICU Specific Indications:
- Intubated patient recently transferred from the operating room to PICU and is planned for early extubation
- To facilitate controlled or deep extubation after discontinuation of other sedative hypnotic agents
- Short duration surgical or interventional/diagnostic procedures performed in the PICU.
- To facilitate transport of patients from PICU to other hospital sites or Ottawa Hospital.
- Rapid sequence intubation where other agents are unsuitable or contra-indicated
- Available as a 10 mg/mL, white, oil-in-water emulsion.
- Protect from light. Store between 2-25°C. DO NOT FREEZE
- Shake well before use
- DO NOT use if phase separation is evident
- Use diluted solutions within 6 hours of preparation
- Solutions Compatible: D5W, ringer's lactate, D5W-RL, D5W-1/2NS, D5W-1/4NS
(Manufacturer recommends that ONLY D5W be used to dilute propofol and to a concentration >2 mg/mL)
- Additive/buretrol Compatible: do not mix with other drugs
- Y-site Compatible: acyclovir, ampicillin, clindamycin, dobutamine, dopamine, epinephrine, fentanyl, fluconazole, ganciclovir, glycopyrrolate, heparin, hyrdromorphone, imipenem-cilastatin, ketamine, labetalol, lidocaine, magnesium sulfate, morphine, nitroglycerin, norepinephrine, KCl, phenylephrine, propanolol, scopolamine, sodium bicarbonate, nitroprusside, amino acids/dextrose
- Incompatible: amikacin, amphotericin B, atracurium, blood products, bretylium, calcium chloride, ceftazidime, cisatracurium, ciprofloxacin, diazepam, digoxin, lipids (fat emulsion), gentamicin, methylprednisolone, metoclopramide, phenytoin, tobramycin, verapamil
(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)
| SC | NO |
| IM |
NO |
| IV Direct |
YES, administer in large vein (ex. antecubital) |
| IV Intermittent Infusion | NO |
| IV Continuous Infusion | YES administer in large vein (ex. antecubital)
Standard Concentration in ER/OR/PICU: 10 mg/mL |
Click here to access SDC Drug Infusion Sheet
(For neonatal dosages, refer to Neonatal IV Drug Manual.)
PICU Specific Dosage
Sedation for mechanically ventilated patient in PICU:
Bolus dosing : 0.5 mg to 2 mg/kg/dose
Infusion: 5 mcg to 66 mcg/kg/minute
A TOTAL DOSE DOSE MUST BE CALCULATED BY THE ANAESTHESIOLOGIST FOR EACH 4 HOUR PERIOD. THE AVERAGE DOSE OVER EACH 4 HOUR PERIOD IS < 4 mg/kg/hr.
ED Specific Dosage
- Procedural Sedation: Initial 0.5 mg/kg/dose. Titrate to effect in 0.5 mg/kg/dose increments Q30 - 60 seconds.
- Propofol infusion syndrome: sudden development of severe metabolic acidosis, acute cardiac conduction abnormalities, fatty liver infiltration and associated rhabdomyolysis in patients who receive high doses of propofol over several days.
- Hypotension, bradycardia
- Vein irritation and pain
- Respiratory depression
- Headache, flushing, GI upset, twitching, myalgias
- Anaphylactoid reactions
Contraindications:
- Patients with congenital respiratory chain metabolic abnormalities including short-chain-acyl-CoA dehydrogenase deficieny and mitochondrial myopathies
- Patients on ketogenic diet
- Known allergy to propofol, eggs or soybean.
Cautions:
Significant metabolic acidosis within the previous 4 hours. Anion gap metabolic acidosis, with a pH < 7.28, or HCO3 < 18, or base deficit > 4. Renal dysfunction within the previous 12 hours. Urine output < 0.5 mL/kg/hr and serum creatinine > 150% age adjusted normal value. Hepatic dysfunction within the previous 24 hours. Alterations in hepatocellular, canalicular or synthetic liver function tests over 150% age adjusted normal value. Hemodynamic instability. Fluctuations in cardiac output (heart rate and/or stroke volume ) or change in prescribed therapy (preload or vasoactive medication) within 15 minutes of commencing propofol Cardiac conduction abnormalities. Brady/tachy dysrhythmias or any degree of heart block. Recent (< 24 hours) onset cardiac conduction abnormality, which has not been stabilized for a period of at least 6 hours. Myoglobinuria. If patient is receiving intravenous lipids in TPN, adjust lipid infusion to account for lipid content of propofol. Propofol contains lipid 0.1 g/mL. Epilepsy, increased intraocular pressure, impaired cerebral circulation.
MONITORING:
Bolus - BP, RR, HR Q1H
- depth of sedation assessments using Sedation Behavioural Scale and Modified Comfort Score Q4H and PRN
Infusion - BP, RR, HR, oxygen saturations, depth of sedation assessments using Sedation Behavioral Scale and Modified Comfort Score Q4H and PRN
- For infusions longer than 24 hours also do - Arterial blood gases Q4H
- Liver function tests, triglycerides & creatinine kinase daily
Other:
DIPRIVAN® contains disodium edetate, egg lecithin and soybean oil Not recommended for the induction of anesthesia in children < 3 years or for maintenance of anaesthesia in infants < 2 months of age Use strict aseptic technique when handling the drug as it contains no preservative and is susceptible to microbial contamination Concurrent use of fentanyl with propofol may cause serious bradycardia Do not administer via filter with <5 micron