Propofol Disease Interactions

Propofol can induce severe hypotension and/or cardiovascular depression, particularly during the induction phase of sedation or anesthesia. Use of propofol infusions for both adult and pediatric ICU sedation has been associated with a constellation of metabolic derangements and organ system failures, referred to as Propofol Infusion Syndrome, that have resulted in death. The syndrome is characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis,hepatomegaly, renal failure, ECG changes (ST segment elevation similar to that in Brugada syndrome) and/or cardiac failure. Therapy with propofol should be administered cautiously in patients with preexisting cardiovascular disorders, hemodynamic impairment, increased intracranial pressure, or impaired cerebral circulation.

Propofol is formulated in an oil-and-water emulsion and elevated triglycerides can occur during extended therapy. Propofol should be administered cautiously in patients with lipid disorders such as primary hyperlipoproteinemia, diabetic hyperlipemia, and pancreatitis. Each milliliter of propofol contains 0.1g of fat (1.1 kcal).

At high doses (2-3 grams per day), EDTA has been reported, on rare occasions, to be toxic to the renal tubules. Studies to-date, in patients with normal or impaired renal function have not shown any alteration in renal function with propofol Injectable Emulsion containing 0.005% disodium edetate. In patients at risk for renal impairment, urinalysis and urine sediment should be checked before initiation of sedation and then be monitored on alternate days during sedation.

Patients with seizure disorders are at increased risk of seizure activity during the recovery phase of sedation or anesthesia following administration of propofol. Clinical monitoring of seizure activity is recommended in patients with or predisposed to seizure disorders.

Reports of mean urinary zinc loss during propofol therapy was approximately 2.5 to 3.0 mg/day in adult patients and 1.5 to 2.0 mg/day in pediatric patients. Practitioners should consider the administration of supplemental zinc during prolonged therapy with propofol in patients who are predisposed to zinc deficiency, such as those with burns, diarrhea, and/or major sepsis. Monitoring is recommended in these patients.