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Propofol - 6
Uses, Doses
Induction and Maintenance of General Anesthesia
- Induction: 1-2.5 mg/kg
- Maintenance: 50-200 mcg/kg/min +/- N2O or opioid or ketamine
- ED95 2.25-2.5 mg/kg
- Onset 1 arm-brain time
- Duration: 3-6 minutes
- Pediatrics: not much change
- maybe 3 mg/kg induction dose in healthy young children
- slightly higher maintenance doses may be expected
- Fast recovery and return of psychomotor function
- within 8-10 minutes after up to 2 hours infusion
- almost as fast as desflurane and with less nausea and vomiting
- Cardiac surgery
- not associated with hypotension if boluses are avoided
- no change in coronary sinus flow, MVO2, or myocardial lactate extraction
- Cp required: 2.5-6 mcg/ml
- TIVA: propofol + ketamine
- propofol:ketamine = 4:1 (or even 8:1 for less painful procedures)
- stable hemodynamics
- no negative dreaming or abnormal behavior
Sedation
- Readily titratable, rapid recovery, by infusion
- ICU: 4 days sedation ->
- 10 minutes to recover
- Cp for sedation stable 96 hours (no tolerance)
- 25-60 mcg/kg/min
- amnesia - yes
- compared to midazolam
- equal or better control
- more rapid recovery (and extubation)
- PCS, patient controlled sedation, has been reported effective
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