Propofol

INTRODUCTION

Indications

Induction of general anesthesia in children >3 yr and adults. Maintenance of balanced anesthesia when used with other agents in children >2 mo and adults. Initiation and maintenance of monitored anesthesia care (MAC). Sedation of intubated, mechanically ventilated patients in intensive care units (ICUs).

Action

Short-acting hypnotic. Mechanism of action is unknown. Produces amnesia. Has no analgesic properties. Therapeutic Effects: Induction and maintenance of anesthesia.

Adverse Reactions/Side Effects

CNS: dizziness, headache. Resp: APNEA, cough. CV: bradycardia, hypotension, hypertension. GI: abdominal cramping, hiccups, nausea, vomiting. Derm: flushing. Local: burning, pain, stinging, coldness, numbness, tingling at IV site. MS: involuntary muscle movements, perioperative myoclonia. GU: discoloration of urine (green). Misc: PROPOFOL INFUSION SYNDROME, fever.

PHYSICAL THERAPY IMPLICATIONS^*

Examination and Evaluation

• Assess respiration and notify physician immediately if patient exhibits any interruption in respiratory rate (apnea) or signs of respiratory depression, including decreased respiratory rate, confusion, bluish color of the skin and mucous membranes (cyanosis), and difficult, labored breathing (dyspnea). Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function. Apnea or excessive respiratory depression requires emergency care.

• Assess heart rate, ECG, and heart sounds, especially during long-term (>24 hr) administration to children or critically ill patients. Be especially alert for an unusually slow heart rate (bradycardia) that can progress to asystole. Bradycardia and other arrhythmias may indicate propofol infusion syndrome, a potentially fatal event accompanied by metabolic acidosis, rhabdomyolysis, and renal failure. Report these signs to the physician or nursing staff immediately.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

• Be alert for residual muscle rigidity and involuntary muscle movements. Report any sustained or problematic changes in muscle tone or excitability.

• If used during mechanical ventilation, observe whether the patient is adequately sedated and the chest wall is relaxed and compliant with ventilation. Notify physician or nursing staff if the patient is agitated or appears to be resisting mechanical ventilation.

• Assess residual dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection-site reactions to the physician.

Interventions

• Because of the risk of respiratory depression, arrhythmias, and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently ...