Dr Mark Moore


Anesthesia Medications


Mark Moore, MD
Tallahassee Anesthesiology, PA

Anesthesia Medications

Propofol

Propofol (Diprovan, Diprivan, Dipravan, Deprovan)
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Propofol (brand name Diprovan): an intravenous anesthetic used to produce rapid induction of anesthesia with a rapid emergence and with relatively low incidence of post-operative nausea and vomiting.
Propofol is classified as a sedative-hypnotic and has become the induction drug of choice for many procedures due to its rapid induction, clearance, and low incidence of nausea compared to other IV anesthetics. It is thought to act by interacting with gamma-aminobutyric acid (GABA) and decreasing GABA’s rate of disassociation from GABA-activated chloride ion channels, thereby hyperpolarizing the cells and preventing further signaling. Potential side effects may include decreases in blood pressure, heart rate, respiratory rate, and cerebral blood flow. In addition, a sensation of pain at the site of intravenous administration is a common occurrence. Dosage is usually between 1.5 to 2.5 mg/kg IV and unconsciousness (as established by unresponsiveness) is achieved within 30 seconds to two minutes. Propofol does cross the placenta but is quickly cleared from neonatal circulation. Propofol may also be used as a continuously infused sedative during mechanical ventilation in critically ill patients.

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Diprivan is a short-acting intravenous anesthetic agent used for the induction of general anesthesia in adult patients and pediatric patients older than 3 years of age; maintenance of general anesthesia in adult patients and pediatric patients older than 2 months of age; and intensive care unit (ICU) sedation for intubated, mechanically ventilated adults.

Diprivan is approved for the induction and maintenance of anesthesia in more than 50 countries.

Initial clinical trials were in 1977, in a form solubilised in cremophor EL, but due to anaphylactic reactions it was withdrawn from the market. It was subsequently reformulated as an aqueous emulsion in intralipid and re-launched in 1986 by AstraZeneca with the brand name Diprivan (Sometimes Diprovan). The current preparation is 1% Diprivan solubilised with 2.25% glycerol, 10% soybean oil and 1.2% purified egg phospholipid, and has a pH between 6.0 and 8.5 and a pKa of 11. Diprivan contains EDTA as an antimicrobial agent. Newer generic formulations contain sodium metabisulfite or benzyl alcohol. Diprivan is one of the few commonly-used anesthetic drugs which can easily be identified by sight alone; it appears as a highly opaque white fluid whereas nearly all other anesthetics are clear and resemble water.

It is highly protein bound in vivo and is metabolised by conjugation in the liver. Its rate of clearance exceeds hepatic blood flow, suggesting an extrahepatic site of elimination as well. Its mechanism of action is uncertain, but it is postulated that its primary effect may be at the GABA-A receptor.

Aside from the hypotension and transient apnea following induction doses, one of its most frequent side-effects is pain on injection, especially in smaller veins. This pain can be mitigated by pretreatment or mixing with intravenous lidocaine. Alternative formulations with a larger proportion of medium-chain triglycerides (as opposed to Intralipid) appear to have less pain on injection, possibly due to lower concentrations of free aqueous Diprovan.

It appears to be safe for use in porphyria, and has not been known to trigger malignant hyperpyrexia. The elimination half-life of Diprivan has been estimated to be between 2-24 hours. However, its duration of clinical effect is much shorter because Diprivan is rapidly distributed into peripheral tissues.

source: wikipedia.org

common misspellings: diprovan, deprivan, deprovan, dipravan, dapravan, daprivan, dipervan, dipirvan, diprivin, dipravin, diprovin, dipriven, dipraven, propifil, propofil, pripofol, propafol, propafil, propophol