Context

Propofol (2-6 di-isopropylphenol) is a short acting hypnotic agent, which induces sedation in lower doses, and general anaesthesia in higher doses. It is one of the most commonly used anaesthetic drugs in the world.

The pharmacokinetics of propofol are complex, but typically it has a rapid onset of action causing an effect within one arm-brain circulation (generally under a minute), and rapid offset due to redistribution into tissues following a single bolus (generally in under 10 minutes). Repeated boluses or an infusion will lead to a prolonged duration of action.

The effects of propofol vary widely between individuals. Generally, patients who are older, sicker or intoxicated with other depressant drugs will have a more pronounced response to propofol. Younger patients or those with a background of alcohol dependence generally require higher doses to achieve the same effect.

Propofol has no analgesia effects, so when being used for procedural sedation it is often given with a short acting opioid, such as fentanyl, which will potentiate its effect. An alternative is to co-administer ketamine (“ketofol”), a practice that has both proponents and detractors, and is outside the scope of this module.

The key to safe use of propofol for procedural sedation in the emergency department is careful titration – you can always give more, but once given you cannot take it away!

The use of propofol for procedural sedation in emergency medicine was first reported in 1995. [1] Studies have since demonstrated a safety profile equivalent to benzodiazepine/opiate combinations. [2] Its safe use by emergency physicians has been established [3] and promoted. [4] The Royal College of Emergency Medicine (RCEM, with the support of the Royal College of Anaesthetists (RCoA) endorses the use of propofol by trained emergency physicians. [5, 6]