INSTITUT LATIHAN KEMENTERIAN KESIHATAN MALAYSIA KOTA KINABALU

KURSUS DIPLOMA PEMBANTU PERUBATAN

CASE STUDY

TITLE
THE USE OF PROPOFOL IN THE
OPERATING THEATRE

NAME : ALIAS BIN SABLE

IDENTITY CARD NO : 940106-12-6227

MATRICS CARD NO : BPP2015-3721

YEAR INTAKE : JULY 2015

SEMESTER : FIVE (5)

PLACEMENT UNIT : OPERATING THEATRE HOSPITAL KOTA BELUD

 CONTENT

NO. TITLE PAGE

1 Introduction 3

2 Literature Review 4

3 Discussion 5

4 Conclusion 6

5 References 7

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INTRODUCTION

Propofol is a short-acting medication that has been used to decrease the level of
consciousness and lack of memory for events. Its uses include the starting and maintenance
of general anaesthesia, sedation for ventilated adults, and procedural sedation. It is also used
for status epilepticus if other medications have not worked. It is given intravenously.
Maximum effect takes about two minutes to occur and it typically lasts five to ten minutes.

Like any regular drugs, patients that will be given the propofol to prepare for surgeries will
experiences the side effects, this include an irregular heart rate, low blood pressure, burning
sensation at the site of injection, and the stopping of breathing. Other serious side effects may
include seizures, infections with improper use, addiction, and propofol infusion
syndrome with long-term use. It appears to be safe for using during pregnancy but has not
been well studied in this group. However, it is not recommended during Lower
Segment Caesarean Section (LSCS). Propofol is not a pain medication, so opioids such
as morphine may also be used. Whether or not they are always needed is unclear.

Propofol was discovered in 1977. It is on the World Health Organization's List of Essential
Medicines, the most effective and safe medicines needed in a health system. It is available as
a generic medication. It has been referred to as milk of amnesia of the milk-like appearance
of the intravenous preparation. Propofol is also used in veterinary medicine.

Strict aseptic technique must always be maintained during handling. Propofol is a single
access parenteral product (single patient infusion vial) which contains 0.005% disodium
edetate (EDTA) to inhibit the rate of growth of microorganisms, for up to 12 hours, in the
event of accidental extrinsic contamination. However, Propofol can still support the growth
of microorganisms, as it is not an antimicrobially preserved product under USP standards.

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LITERARTURE REVIEW

As a young academic anaesthesiologist and clinical pharmacologist working in the

Department of Anaesthesia at Stanford University Medical Centre (Stanford, California), I
was intrigued by the potential of propofol, a novel intravenous anaesthetic, to facilitate the
transition of surgical care from the inpatient to the outpatient setting. By developing a more
in-depth understanding of propofols pharmacokinetics and dynamics properties, I believed
that propofol could become a useful drug for both induction and maintenance of general
anaesthesia, as well as for sedation in operating rooms, diagnostic centres, and intensive care
units (Paul F. White, Ph.D., M.D., F.A.N.Z.C.A, 2008)

Propofol has found increasing popularity with anaesthetists for sedation in the operating
theatre. This is a review of the current literature looking at the use of propofol for procedural
sedation in the emergency department. A comprehensive literature search of Medline from
1966 to week 4 of 2005, Embase from 1980 to week 10 of 2005, and the Cochrane Library
was carried out using the OVID interface. Eight articles were selected for review. The
evidence suggests that propofol is both effective and safe to use in the emergency
department. (Emerg Med J. 2006)

Propofol has been shown in clinical studies to be a safe, effective, hypnotic, and amnesic
anaesthetic agent at induction doses of 2-2.5 mg/kg and maintenance doses of approximately
9mg/kg per hour. Significant post-induction hypotension reported earlier can be reduced to a
all in MAP of less than 25% when the drug is used alone (without nitrous oxide or narcotic
premedication). Post-induction apnoea is minimized by avoidance of pre-induction
hyperventilation. Acute and long term venous tolerance is acceptable. Emergence from
anaesthesia induced and maintained with propofol is rapid, predictable and relatively free of
postoperative complications. Incidence of drug interaction is low. Propofol causes no
adrenocortical suppression and is not potentiated by ethanol, diazepam, amitriptyline or
phenelzine. Preliminary investigation of propofol as an intravenous sedative agent at
subanesthetic doses has been favourable. (Anesth Prog. 1988 Jul)

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Propofol is a rapidly acting intravenous anaesthetic agent which has many advantageous
kinetic properties explaining its usefulness by bolus dose for induction of anesthesia or for
administration by continuous intravenous infusion. It is rapidly distributed in the body with a
half-life of only around 2 min and has an efficient hepatic and extra hepatic clearance (total
body clearance may exceed liver blood flow). Premedication has little effect on the already
good induction characteristics of propofol. (Int J Clin Pharmacol Ther Toxicol. 1988)

DISCUSSION

Throughout my clinical attachment at Operation Theatre Hospital Kota Belud, I can conclude
that propofol is a common anaesthesia that has been used for many types of surgeries.
Although propofol is one of the most commonly used drugs for induction of anaesthesia, it is
not devoid of anaphylactic potential. Early detection of any suspected anaphylactic reaction
during anaesthesia, prompt management, identification of the offending agent and prevention
of exposure to the offending agent in the future is the responsibility of the anaesthesiologist.

Anaphylaxis is an acute life-threatening systemic reaction that requires quick diagnosis and
correct management to save the patient. Although it is a rare intra-operative complication,
most drugs used in the peri-operative period can lead to anaphylaxis. The incidence of
anaphylaxis during anaesthesia has been estimated between 1 in 10,000 and 1 in 20,000. The
rate of mortality ranges between 3 and 9%. Ninety percent of the anaphylactic reactions occur
at the time of induction of anaesthesia.

Nowadays, propofol is the most widely used drug not only for induction of anaesthesia but
also for sedation in various settings such as short surgical procedures under total intravenous
anaesthesia, intensive care settings and paediatric procedures.

The symptoms that may occurs when the patient is allergic to propofol is the presence of
cutaneous rash all over the body, oedema over the face and upper limbs and severe
hypotension

Every patient with a suspected anaphylactic reaction during anaesthesia should be

investigated to determine the allergic nature of the reaction and to identify the responsible
drug with the aim of providing safe and documented advice for future administration of
anaesthetic drug

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CONCLUSION

Propofol is an intravenous anaesthetic agent that has become widely used in day case surgery.
It induces anaesthesia rapidly and 'smoothly', is associated with a quick recovery and has a
lower incidence of postoperative nausea and vomiting (PONV) than other agents. In studies
comparing propofol with other intravenous anaesthetics (most commonly thiopental sodium)
in day case surgery, the use of propofol as induction and/or maintenance anaesthesia was
associated with a shorter time to intermediate recovery in term of street fitness or time to
discharge, although the mean time difference was generally less than 1 hour. However, when
compared with volatile anaesthetics such as Desflurane, the differences in time to discharge
were smaller. Propofol is also associated with less PONV than barbiturates, volatile
anaesthetics or barbiturate/volatile anaesthetic combinations in the immediate postoperative
period. The faster recovery time and the decreased incidence of PONV have potential
pharmacoeconomic implications.

REFERENCES

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Books

1. Albertina Florence (25 April) 2015). Propofol: Pharmacokinetics, Medical Uses and
Potential Health Effect
2. Dr Khathija Hasan, Dr Uwais Riaz Ul Hasan, Dr Atif Baig (11 Dec 2014). Propofol
and cognition: An Experience in East Cost Malaysia

Online Article

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554966/ (12 August 2017)

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4524929/ (12 August 2017)

3. http://www.journalacs.org/article/S1072-7515(13)00607-8/abstract (12 August 2017)

4. http://journals.lww.com/ejanaesthesiology/Fulltext/2011/07000/Is_propofol_an_analg

esic_.3.aspx ( 12 August 2017)

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237159/ (12 August 2017)

6. https://www.drugs.com/pro/propofol.html (12 August 2017)

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