(by slow intravenous injection) 10 – 20 mg, (if rapid
increase in sedation required)
Maintenance of sedation for surgical and diagnostic
procedures using 2 % injection
▶INITIALLY BY INTRAVENOUS INFUSION
▶Child 3–16 years:Usual dose 1. 5 – 9 mg/kg/hour, dose
and rate of administration adjusted according to
desired level of sedation and response
▶Child 17 years:Initially 1. 5 – 4. 5 mg/kg/hour, dose and
rate of administration adjusted according to desired
level of sedation and response, followed by (by slow
intravenous injection) 10 – 20 mg, using 0. 5 %or 1 %
injection (if rapid increase in sedation required)IMPORTANT SAFETY INFORMATION
Propofol should only be administered by, or under the
direct supervision of, personnel experienced in its use,
with adequate training in anaesthesia and airway
management, and when resuscitation equipment is
available.lCONTRA-INDICATIONSChildren under 16 years receiving
intensive care
CONTRA-INDICATIONS, FURTHER INFORMATION
Use in intensive care associated with a risk of propofol
infusion syndrome (potentially fatal effects, including
metabolic acidosis, arrhythmias, cardiac failure,
rhabdomyolysis, hyperlipidaemia, hyperkalaemia,
hepatomegaly, and renal failure).
lCAUTIONSAcute circulatory failure (shock).cardiac
impairment.cardiovascular disease.epilepsy.fixed
cardiac output.hypotension.hypovolaemia.raised
intracranial pressure.respiratory impairment
lINTERACTIONS→Appendix 1 : propofol
lSIDE-EFFECTS
▶Common or very commonApnoea.arrhythmias.headache.
hypotension.pain.nausea.vomiting
▶UncommonThrombosis
▶Rare or very rareEpileptiform seizure (may be delayed).
pancreatitis.post procedural complications.pulmonary
oedema.sexual disinhibition.urine discolouration
▶Frequency not knownDrug use disorders.dyskinesia.
euphoric mood.heart failure.hepatomegaly.
hyperkalaemia.hyperlipidaemia.metabolic acidosis.
renal failure.respiratory depression.rhabdomyolysis
SIDE-EFFECTS, FURTHER INFORMATION
BradycardiaBradycardia may be profound and may be
treated with intravenous administration of an
antimuscarinic drug.
Pain on injectionPain on injection can be reduced by
intravenous lidocaine.
Propofol infusion syndromeProlonged infusion of
propofol doses exceeding 4 mg/kg/hour may result in
potentially fatal effects, including metabolic acidosis,
arrhythmias, cardiac failure, rhabdomyolysis,
hyperlipidaemia, hyperkalaemia, hepatomegaly, and renal
failure.
lPREGNANCYMay depress neonatal respiration if used
during delivery.
Dose adjustmentsMax. dose for maintenance of
anaesthesia 6 mg/kg/hour.
lBREAST FEEDINGBreast-feeding can be resumed as soon
as mother has recovered sufficiently from anaesthesia.
lHEPATIC IMPAIRMENTUse with caution.
lRENAL IMPAIRMENTUse with caution.
lMONITORING REQUIREMENTSMonitor blood-lipid
concentration if risk of fat overload or if sedation longer
than 3 days.lDIRECTIONS FOR ADMINISTRATIONShake before use;
microbiologicalfilter not recommended; may be
administered via a Y-piece close to injection site co-
administered with Glucose^5 %orSodium chloride^0.^9 %.
0. 5 %emulsionfor injection or intermittent infusion; may
be administered undiluted, or diluted with Glucose 5 %or
Sodium chloride 0. 9 %; dilute to a concentration not less
than 1 mg/mL. 1 %emulsionfor injection or infusion; may
be administered undiluted, or diluted with Glucose 5 %
(Diprivan®)or(Propofol-Lipuro®)orSodium chloride 0. 9 %
(Propofol-Lipuro®only); dilute to a concentration not less
than 2 mg/mL; use within 6 hours of preparation. 2 %
emulsionfor infusion; do not dilute.
lPATIENT AND CARER ADVICE
Driving and skilled tasksPatients given sedatives and
analgesics during minor outpatient procedures should be
very carefully warned about the risk of driving or
undertaking skilled tasks afterwards. For a short general
anaesthetic the risk extends toat least 24 hoursafter
administration. Responsible persons should be available to
take patients home. The dangers of takingalcoholshould
also be emphasised.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Emulsion for infusion
▶Propofol (Non-proprietary)
Propofol 10 mg per 1 mlPropofol 500 mg/ 50 ml emulsion for
infusion vials| 1 vialP£ 3. 00 (Hospital only)
Propofol-Lipuro 1 % emulsion for infusion 50 ml vials| 10 vialP
£ 97. 56 (Hospital only)
Propofol 1 g/ 100 ml emulsion for infusion vials| 1 vialP£ 4. 00
(Hospital only)
Propofol 20 mg per 1 mlPropofol 1 g/ 50 ml emulsion for infusion
vials| 1 vialP£ 3. 50 (Hospital only)
▶Diprivan(Aspen Pharma Trading Ltd)
Propofol 10 mg per 1 mlDiprivan 1 % emulsion for infusion 50 ml
pre-filled syringes| 1 pre-filled disposable injectionP£ 10. 68
Propofol 20 mg per 1 mlDiprivan 2 % emulsion for infusion 50 ml
pre-filled syringes| 1 pre-filled disposable injectionP£ 15. 16
Emulsion for injection
▶Propofol (Non-proprietary)
Propofol 10 mg per 1 mlPropofol 200 mg/ 20 ml emulsion for
injection vials| 5 vialP£ 4. 00 (Hospital only)
▶Diprivan(Aspen Pharma Trading Ltd)
Propofol 10 mg per 1 mlDiprivan 1 % emulsion for injection 20 ml
ampoules| 5 ampouleP£ 15. 36 (Hospital only)
▶Propofol-Lipuro(B.Braun Melsungen AG)
Propofol 5 mg per 1 mlPropofol-Lipuro 0. 5 % emulsion for injection
20 ml ampoules| 5 ampouleP£ 15. 15ANAESTHETICS, GENERAL›VOLATILE LIQUID
Volatile halogenated f
anaesthetics
IMPORTANT SAFETY INFORMATION
Should only be administered by, or under the direct
supervision of, personnel experienced in their use, with
adequate training in anaesthesia and airway
management, and when resuscitation equipment is
available.lCONTRA-INDICATIONSSusceptibility to malignant
hyperthermia
lCAUTIONSCan trigger malignant hyperthermia.
neuromuscular disease (inhalational anaesthetics are very
rarely associated with hyperkalaemia, resulting in cardiac
arrhythmias and death).raised intracranial pressure (can
increase cerebrospinal pressure)806 General anaesthesia BNFC 2018 – 2019
Anaesthesia15