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To induce general anesthesia, propofol is the drug used almost exclusively, having largely replaced sodium thiopental. [13]It is often administered as part of an anesthesia maintenance technique called total intravenous anesthesia, using either manually programmed infusion pumps or computer-controlled infusion pumps in a process called target controlled infusion (TCI).
Propofol – It is a highly lipid-soluble, GABA agonist. [15] The dosage is 1.5 mg/kg (usually 100 to 200 mg). It has quick onset of action, can cross the blood-brain barrier, wide tissue distribution, and can be hepatically cleared by the body quickly. [15] In the elderly, the rate of Propofol clearance is low.
Most propofol is conjugated in the liver with pharmacologically inactive metabolites. [33] Although it has a long terminal elimination half-life of 4 to 30 hours, plasma concentrations remain low after the typical induction dose. [33]
Propofol infusion syndrome (PRIS) is a rare syndrome which affects patients undergoing long-term treatment with high doses of the anaesthetic and sedative drug propofol. It can lead to cardiac failure , rhabdomyolysis , metabolic acidosis , and kidney failure , and is often fatal.
Propofol can be used for total intravenous anaesthetia (TIVA), therefore supplementation by inhalation agents is not required. [45] General anesthesia is usually considered safe; however, there are reported cases of patients with distortion of taste and/or smell due to local anesthetics, stroke, nerve damage, or as a side effect of general ...
The maximum dose is used, rather than a lower dose, to reduce the number of test subjects (and, among other things, the cost of testing), to detect an effect that might occur only rarely. This type of analysis is also used in establishing chemical residue tolerances in foods. Maximum tolerated dose studies are also done in clinical trials.
Fospropofol is metabolized in the liver by alkaline phosphatases to propofol, formaldehyde, and phosphate.The hepatic metabolism of this prodrug to an active metabolite means that peak plasma levels of propofol after the administration of a bolus of fospropofol are lower than for an equipotent dose of propofol and also that its clinical effect is more sustained.
Intrathecal administration is often used for a single 24-hour dose of analgesia (opioid with local anesthetic). Caution should be exercised with intrathecal opioids due to the risk of late onset hypoventilation. The use of intrathecal morphine may be limited by severe pruritus and urinary retention. [citation needed]