Introduction and maintenance of general anesthesia; as a calming drug for minor medical procedures (sedation with consciousness); as a sedative during controlled breathing in adult patients in intensive care units.
Composition:
1 vial of 20 ml contains 200 mg propofol.
Action:
A short-acting intravenous hypnotic (anesthetic) with an unknown mechanism of action. After intravenous administration within 30 seconds, it causes sleep; wake up after a single dose - after 3-5 min. Fast start and short duration of action make it easier to control the depth of anesthesia. After bolus administration, the blood pressure is reduced (systolic and diastolic by about 20%), the systemic peripheral resistance decreases, small changes in heart rate, and a slight decrease in cardiac output. It reduces intracranial pressure, cerebral flow and brain metabolism. It is 98% bound to plasma proteins. Pharmacokinetics in three stages - fast distribution by T0,5 about 2-4 min, quick elimination from T0,5 30-60 min and slow release phase from poorly supplied blood vessels. It is metabolized in the liver (over 90%), inactive propofol and quinol are excreted in the urine. Does not tend to accumulate in the body, does not inhibit the synthesis of adrenocortical hormones. It crosses the placenta barrier. It does not show any significant analgesic effect (in the case of anesthesia it is advisable to combine it with an analgesic).
Contraindications:
Hypersensitivity to propofol or other ingredients of the preparation (including egg lecithin or soybean oil). Do not use for sedation with artificial ventilation for more than 3 days; Do not use during electroconvulsive therapy. Do not use in children under 3 years of age and for sedation in IT conditions in patients <16 years.
Precautions:
The preparation can be used only by a specialist in anaesthesiology or intensive care. During use, the possibility of oxygen therapy and cardiopulmonary resuscitation should be ensured. Due to the possibility of anesthesia of involuntary movements, care should be taken in procedures requiring complete immobilization of the patient. Caution should be exercised in deprived patients, with cardiovascular, respiratory, hepatic, renal, cardiac disorders, hypovolaemia, lipid metabolism disorders, epilepsy (risk of seizure), in older age. Due to the lack of a cholinolytic effect - when introducing anesthesia, anticholinergic drug should be considered, especially in patients at risk or in combination with drugs that may cause bradycardia. In patients with increased intracranial pressure, appropriate treatment to improve cerebral flow should be used.
Pregnancy and lactation:
Do not use in pregnant women; can be used for anesthesia for abortion in the first trimester. Do not use in obstetric anesthesia (it crosses the placenta, it can cause circulation or breathing failure in the newborn). There are no data on the safety of use in lactating women.
Side effects:
Very often (> 1/10) pain at the injection site was noted; often (<1/10;> 1/100) - hypotension, bradycardia (including severe, asystole), redness of the face, transient apnea, nausea and vomiting during recovery, withdrawal symptoms after a long infusion; uncommon (<1/100;> 1/1000) - thrombosis, phlebitis; rarely (<1/1000;> 1/10000) - epileptiform movements (convulsions, myoclonus, opistononus); very rare (<1/10000) - prolonged wake-up time, decay of striated muscles (cases involving IT sedation with a dose> 4 mg / kg / h), pancreatitis, fever, changes in urine color (after long-term use), anaphylaxis ( angioedema, bronchospasm, erythema, hypotension), pulmonary edema, metabolic acidosis, hyperkalemia, heart failure. Serious side effects (including fatalities) related to non-prescribed dosages (eg high doses in children).
Dosage:
Intravenously. Introduction to anesthesia: adults <55 r. - 1.5-2.5 mg / kgin divided doses every 10 seconds until the onset of sleep symptoms; adults> 55 years and from 3 and 4 ASA groups - doses should be reduced, approx. 20 mg every 10 seconds; drug can be given in bolus or infusion; children over 8 years of age - usually 2.5 mg / kg, younger children may require a higher dose; in children from the 3rd and 4th ASA group the dose should be reduced. Maintenance of anesthesia: adults - administration in repeated bolus - 25 - 50 mg as needed or infusion - 4-12 mg / kg / h; children> 3 years - 9-15 mg / kg / h, depending on the need. Sedation with consciousness in adults - 0.5-1.0 mg / kg during 1-5 min; the rate of infusion is 1.5-4.5 mg / kg / h; if necessary, you can also give 10-20 mg of propofol in a single injection, in patients> 55 years, the dose should be reduced. It should only be used after diluting with a 5% Glucose solution in the ratio of 1 vol. + 4 vol. glucose (ie 0.2% solution) or - to reduce pain at injection - dilute with 0.5-1.0% lignocaine hydrochloride (20 vol. + 1 vol. lignocaine). The preparation can be combined with alfentanil (from 20: 1 to 50: 1).
(C)
