Propofol (2, 6-diisopropylphenol) is a potent intravenous
hypnotic agent which is widely used for the induction and maintenance of
anesthesia and for sedation in the intensive care unit.
Propofol is an oil at room temperature and insoluble in aqueous
solution. Present formulations consists of 1% or 2% (w/v)
propofol, 10%
soybean oil, 2.25%
glycerol, and 1.2% egg phosphatide. Disodium edetate (
EDTA) or
metabisulfite is added to retard bacterial and fungal growth.
Propofol is a global central nervous system depressant. It directly activates
GABA(A) receptors. In addition,
propofol inhibits the
NMDA receptor and modulates
calcium influx through slow
calcium ion channels.
Propofol has a rapid onset of action with a dose-related
hypnotic effect. Recovery is rapid even after prolonged use.
Propofol 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
critically ill septic patients.
Propofol has a remarkable safety profile. Dose dependent
hypotension is the commonest complication; particularly in volume depleted patients.
Hypertriglyceridemia and
pancreatitis are uncommon complications. Allergic complications, which may include
bronchospasm, have been reported with the formulation containing
metabisulfite. In addition, this formulation has been demonstrated to result in the generation of
oxygen free radicals. High dose
propofol infusions have been associated with the "
propofol syndrome"; this is a potentially fatal complication characterized by severe
metabolic acidosis and
circulatory collapse. This is a rare complication first reported in pediatric patients and believed to be due to decreased transmembrane electrical potential and alteration of electron transport across the inner mitochondrial membrane.