Propofol | According to its data sheet, it can produce: Heart, circulatory or pulmonary insufficiency and hypovolemia | Propofol should not be administered to patients with advanced heart failure. | The use of propofol emulsion infusions for sedation in intensive care has been associated with a set of metabolic alterations and systemic organ failures that can cause death.
Advice regarding management in the Intensive Care Unit
The use of propofol emulsion infusions for sedation in intensive care has been associated with a set of metabolic alterations and systemic organic failures that can cause death. Cases of combinations of the following effects have been reported: metabolic acidosis, rhabdomyolysis, hyperkalaemia, hepatomegaly, renal failure, hyperlipidaemia, cardiac arrhythmia, Brugada ECG (ST-segment elevation and inverted T-curve), and rapidly evolving heart failure that usually It usually does not respond to supportive treatment with inotropes. Combinations of these events have been referred to as propofol infusion syndrome.
The main risk factors for the development of these events seem to be the following: decreased oxygen supplied to the tissues; serious neurological injuries and/or sepsis; high doses of one or more of the following pharmacological agents – vasoconstrictors, steroids, inotropic drugs and/or propofol (usually at doses of propofol greater than 4 mg/kg/h for more than 48 hours).
The medical team should remain alert to these events and consider a dose reduction or interruption of propofol administration at the first signs of the onset of the aforementioned symptoms.
Concomitant use of benzodiazepines, parasympatholytic agents, or inhalational anesthetics prolongs anesthesia and reduces respiratory rate.
Bradycardia and cardiac arrest may occur after treatment with suxamethonium or neostigmine.
Leukoencephalopathy has been reported with the administration of lipid emulsions such as propofol in patients treated with cyclosporins.