Sedation in PACU: The Role of Propofol

Abstract

In critically ill patients, adequate sedation increases comfort, minimizes stress response and facilitates diagnostic and therapeutic procedures. Propofol (2-, 6-diisopropylphenol) is an intravenous sedative-hypnotic agent popular for sedation in the Intensive Care Unit. The favorable propofol pharmacokinetic, characterized by a three compartment linear model, allows rapid onset and short duration of action. The emergence time from sedation with propofol varies with the depth and the duration of sedation and the patient's bodyweight. Propofol causes hypotension, particularly in volume depleted patients, decreases cerebral oxygen consumption, reduces intracranial pressure and has potent anti-convulsant properties. It is a potent antioxidant, has anti-inflammatory properties and is a bronchodilator. As a consequence of these properties, propofol is being increasingly used in the management of traumatic head injury, status epilepticus, delirium tremens, status asthmaticus and in septic patients. Prolonged use (>48 h) of high doses of propofol (>66 mcg/Kg/min) has been associated with lactic acidosis, bradycardia, and lipidemia in pediatric patients. A rare complication firstly reported in pediatrics patients and also observed in adults is known as "propofol syndrome" characterized by myocardial failure, metabolic acidosis and rhabdomiolysis. Hyperkalemia and renal failure have also been associated with this syndrome. Hypertriglyceridemia and pancreatitis are uncommon complications. A large number of trials have compared the use of propofol with midazolam. Sedation with propofol is associated with adequate sedation in ICU patients, shorter weaning time and earlier tracheal extubation compared to midazolam, but not before ICU discharge.

Modulatory Effect of Ascorbic Acid on Propofol-Induced Anaesthesia in Goats

“…This finding disagrees with that of Egwu et al, [15], who reported a decrease in respiratory rate after AA administration in rabbits. The result of the present study showed that propofol when administered alone decreased the respiratory rate only after induction, which agreed with the result obtained by De Cosmo et al, [31] that propofol possesses profound respiratory depressant properties in humans. Goats administered with 300 mg/kg AA before propofol induction showed a decrease in respiratory rate during induction.…”

Propofol inhibits cyclo-oxygenase activity in human monocytic THP-1 cells

“…[1][2][3] Since these patients may already be immunosuppressed by preexisting diseases, surgical trauma, and/or overwhelming infection, 4,5 even small adverse effects on immunity, due to the sedative, could be devastating for such patients.…”

Propofol Effect on Stress Response and Free Radicals in Patient during Surgery and Sedation Procedure

“…Propofol gains it's popularity because it has a rapid onset and offset compared with other commonly used ICU sedatives. (9) Besides the relation to stress response, the ICU stay may lead to psychological problems as well. Many patients developing post-traumatic stress syndromes have reported memories of vivid nightmares, hallucinations and altered sense of reality after their discharge from the ICU.…”