Propofol: A Sedative-Hypnotic Anesthetic Agent for Use in Ambulatory Procedures: ADVERSE REACTIONS

In: Anesthesia

15 Jan 2010

Anesthesia

The most common untoward effect elicited by propofol is pain on injection. This is observed in 31% of patients when using the dorsum of the hand and 8% when accessing the vein in the anticubital fossa. Means of alleviating this discomfort include injecting intravenously 10 mg of 1% lidocaine 10 seconds before propofol delivery or mixing it with propofol immediately before infusion.

As previously noted, hypotension can be a frequent side effect. This is usually transient and responds to a decrease in the drug infusion rate. Bradycardia, negative inotropy, and respiratory depression can be seen as well. Propofol should be avoided in pregnant and lactating women because no controlled studies have been carried out in this group. Neuroexcitatory events, such as tremor, twitching, and hiccups, have been reported. Rarely, hallucinations have been described in association with propofol use.
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There have been documented cases of anaphylaxis, although it is difficult to determine if the hypersensitivity was due to the propofol itself or to the lipid vehicle.

For long-term administration, such as children receiving sedation while on mechanical ventilation for laryn-gotracheobronchitis, fatal metabolic acidosis has been reported. No similar occurrence has been observed with propofol administration in the setting of ambulatory surgery. As previously described, propofol has not been reported to be associated with significant hepatic injury and can be used in patients with liver and renal disease.

Incidences of sepsis have been reported after using contaminated bottles of propofol. Microbial growth, including Gram-positive and Gram-negative bacteria and Candida albicans, is supported by propofol both with and without the lipid vehicle. Strict aseptic technique should be followed and vials open for more than 6 hours should not be used. kamagra soft tablets

Less common adverse reactions include nausea, vomiting, and green discoloration of the urine (propofol belongs to a group of phenolic compounds that tend to cause this discoloration). A single case of propofol abuse and dependence has been documented.

CONCLUSION

Propofol, a short-acting intravenous anesthetic agent, is excellent for use in outpatient oral surgery and pediatric procedures. The objectives of anesthesia for ambulatory surgery, including rapid onset, swift emergence with few side effects, and a favorable safety profile, are achieved by propofol. In addition to the advantageous pharmacokinetics, propofol rarely invokes postoperative nausea and vomiting, has no effect on the endocrine and immune systems, and can be administered to patients with hepatic and renal disease. Occasional instances of pain on injection and excitatory responses do not appreciably restrict the use of propofol. More serious complications, namely cardiovascular and respiratory depression, can be observed with propofol and should be understood prior to dosing. The resultant hypotension is often transient and is dose dependent. Also, the reduction in systemic vascular resistance and heart rate can counteract exuberant adrenergic activity. This helps patients cope with surgical stress. Depending on the dose concentration, propofol can invoke sedation or general anesthesia. Intraoperative modification via dose titration can change the anesthetic depth as needed. However, the continuous infusion administration technique is most ideal because it keeps stable blood levels and permits rapid emergence and return to lucidity. Propofol, whether used alone or in combination with other anesthetic agents, provides sound sedation or anesthesia with a quick on/offset that is ideal for treatment in an outpatient setting for those who are properly trained and equipped in the administration of deep sedation and general anesthesia.


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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.

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