The depth of propofol sedation increases in a dose dependent manner. The short context-sensitive half-time of propofol, even with prolonged periods of infusion, make this a readily titratable drug for production of IV sedation.
The prompt recovery without residual sedation and low incidence of nausea and vomiting make propofol particularly well suited to ambulatory conscious sedation techniques. The typical conscious propofol sedation dose is 25 to 100 microgram/kg/minute TV.
A sense of well-being may accompany recovery from conscious propofol sedation although this may be related more to the patient’s relief that the procedure is over than to a specific pharmacologic effect of propofol. Combining propofol infusion with short acting opioids or ketamine can be used for painful surgical procedures in the emergency or outpatient department.
Propofol sedation has been administered as a sedative during mechanical ventilation in the ICU in a variety of patient populations including postoperative patients and patients with head injury.
When given as a continuous intravenous infusion for total intravenous anesthesia or for sedation in intensive care unit propofol has shown little accumulation. Propofol also provides control of stress responses and has anticonvulsant and amnestic properties. In comparison to midazolam, propofol produces faster recovery.
Even after periods of prolonged sedation (>72 hours), propofol was generally associated with a faster time to recovery than midazolam. Propofol facilitated better predictability of recovery and an improved control of the depth of sedation in response to titration than midazolam.
Propofol sedation is also associated with shorter weaning time and earlier tracheal extubation compared to midazolam in mechanically ventilated patients. In patients sedated following head trauma, propofol reduces or maintains intracranial pressure.
Propofol sedation is associated with generally good haemodynamic stability but induces a dose-dependent decrease in blood pressure and heart rate.
However, prolonged use (>48 h) of high doses of propofol (>66 mcg/kg/min) has been associated with lactic acidosis, bradycardia, and lipidaemia (hypertriglyceridaemia).
Propofol syndrome and pancreatitis are other uncommon complications.