Propofol: characteristics and side effects of this drug

What is propofol and how is it used in medicine? Let's take a look at the characteristics of this sedative.

Sedative and anesthetic drugs are one of the basic tools in many operating rooms and intensive care spaces.

Sedation and induction of anesthesia are necessary in many medical acts and surgical interventions, as they block the tactile and painful sensitivity of patients, and facilitate the work of professionals. In this regard, one of the most commonly used drugs is propofol, a powerful fast-acting sedative used as an anesthetic.

In this article we explain what propofol is, what its clinical uses are, what it can be used for, and how it can be used.In this article we explain what is propofol, what are its clinical uses, its mechanism of action, as well as the most common side effects caused by this drug.

Propofol: characteristics and clinical uses

Propofol is a drug in the group of fast-acting sedative hypnotics that is usually administered intravenously.. It was discovered in 1977 and approved for marketing in 1989, and is now considered an effective and safe drug. In some countries it is known as "milk of amnesia" because of the rapid induction of sleep and anesthesia it produces.

This drug is used to initiate and maintain sedation in monitored anesthesia care, in combined sedation and local anesthesia, in induction of general anesthesia, and in intensive care when intubated or mechanically ventilated patients need to be sedated. Propofol is fast acting; its peak effect takes approximately two minutes to occur and usually lasts five to ten minutes.

However, there have been reports of propofol abuse, there have been reports of propofol abuse for recreational and other inappropriate purposes.which have resulted in deaths and other harms. Cases of self-administration of propofol by healthcare professionals have also been reported, with similar episodes. Propofol was also used in executions of death row prisoners, although its use for this purpose was banned in 2013.

Effects and mechanism of action

The mechanism of action of propofol, as with the vast majority of anesthetic drugs, is unknown; however, it has been suggested that this drug produces its sedative and anesthetic effects by positively modulating the inhibitory function of the neurotransmitter GABA, via ligand-activated GABAa receptors.

The pharmacodynamic properties of propofol depend on Blood concentrations of the drug. In patients who maintain spontaneous ventilation, the main cardiovascular effect of propofol is arterial hypertension, with little or no change in heart rate, and no appreciable decrease in cardiac output; however, if ventilation is assisted, there is an increase in the incidence and degree of cardiac output depression.However, if ventilation is assisted, there is an increase in the incidence and degree of cardiac output depression.

Studies have shown that the effects of propofol with respect to induction of anesthesia are generally more pronounced than those of other intravenous induction drugs. Induction of anesthesia with propofol is frequently associated with apnea in both adults and pediatric patients.in both adult and pediatric patients. During maintenance of anesthesia, propofol causes a decrease in spontaneous ventilation per minute, usually associated with an increase in carbon dioxide tension.

Hypotension, oxyhemoglobin desaturation, apnea and airway obstruction may occur during monitored anesthesia care sedation. Particular caution should be exercised in elderly and debilitated patients, as bolus doses (single dose administered over a short period of time) are discouraged for sedation with monitored anesthesia care.

Side effects.

The clinical use of propofol may entail a number of risks and a number of risks and possible adverse effects that are worth considering.. One of the most common side effects of propofol is pain at the injection site, especially when injected into the smaller veins; this pain arises from activation of the TRPA1 pain receptor, located on sensory nerves.

When propofol is used in anesthesia or monitored anesthetic care, common side effects include: bradycardia, tachycardia, arrhythmia, hypertension, burning or stinging on movement, pain at the site of injection, apneaskin rash and pruritus.

In cases where propofol is used for sedation in intensive care units, the most common symptoms are bradycardia, decreased cardiac output, hypotension, hyperlipidemia (presence of elevated blood lipid levels) and respiratory acidosis (increased concentration of carbon dioxide in the blood plasma and decreased blood pH).

Although propofol is frequently used in the adult intensive care setting, special emphasis has been placed on the side effects affecting pediatric patients.In the 1990s, several deaths of children were reported to be related to sedation from this hypnotic and sedative drug. Finally, it should be noted that the respiratory effects of propofol are increased if administered with other depressant drugs (including benzodiazepines).

Propofol infusion syndrome

Propofol infusion syndrome is a rare disorder that affects some patients undergoing long-term propofol infusion long-term treatment with high doses of this anesthetic and sedative drug.. This syndrome usually occurs in children, and critically ill patients receiving catecholamines and glucocorticoids are at increased risk.

This disorder can lead to heart failure, rhabdomyolysis (a disease caused by muscle necrosis), metabolic acidosis and renal failure, and is often fatal. It can also lead to hyperkalemia, increased blood triglycerides and liver enlargement, consequences that could be due to direct inhibition of the mitochondrial respiratory chain or impaired mitochondrial fatty acid metabolism.

Early recognition of the syndrome and discontinuation of the propofol infusion is criticalIt significantly reduces morbidity and mortality. Treatment consists of cardiopulmonary support with inotropes (drugs that increase cardiac contraction), vasopressors and mechanical ventilation. Bradycardia usually does not respond to catecholamine infusion and external pacing.

Hemodialysis and hemofiltration are recommended to remove propofol and its metabolites. Some patients may require extracorporeal membrane oxygenation support. Treatment for rhabdomyolysis includes maintaining intravascular volume and supporting renal function. And in the event of lactic acidosis, aggressive hemodialysis-based treatment is recommended.

Bibliographic references:

• Kang, T. M. (2002). Propofol infusion syndrome in critically ill patients. Annals of Pharmacotherapy, 36(9), 1453-1456.
• Mackenzie, N., & Grant, I. S. (1987). Propofol for intravenous sedation. Anaesthesia, 42(1), 3-6.
• Tan, C. H., & Onsiong, M. K. (1998). Pain on injection of propofol. Anaesthesia, 53(5), 468-476.