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Monday, December 15, 2008

Propofol is not contraindicated in Porphyria

Question 21
Which of the following statements about Propofol is not true
a.       It is Contraindicated in porphyria
b.      It does not trigger Malignant hyperthrermia"   Induction is rapid and recovery of consiousness after 4-7 minutes
c.       Post anaesthetic Performance of Mental, Manual and Mechanical task is back to normal within 1-2 hours
d.      Suited for Day care Surgery
Answer
a) It is contraindicated in Porphyria
Reference
Clinical Anaesthesia 3rd Edition - Morgan Page 173
Also can be Seen at
KDTripathi,4th Edition Page 352
Lee, 12th Edition, Page 417
Quality
Spotter
Status
Repeat
QTDF
All books give this
Discussion
Propofol is Di-Isopropylphenol
  • It is prepared as an emulsion in 10% Soyabean oil and 1.2%egg phosphatide and 2.25%Glycerol
  • Induction dose is 2-3 mg/kg
  • Highly lipophilic
  • 30%-40% of patients complain of pain/burning during injection.
  • Induction is rapid and recovery of consiousness after 4-7 minutes
  • Post anaesthetic Performance of Mental, Manual and Mechanical task is abck to normalwithin 1-2 hours
  • Suited for Day care Surgery
  • Safe for patients with Acute Intermittent Poyphyria
  • It does not trigger Malignant hyperthrermia
  • Hypotension is a common side effect
  • Apnoea is common after induction and may last for 40-50 seconds
  • Antioxidant
  • Antiemetic
  • Antipruritic
Explanation
a.       Propofol is NOT Contraindicated in porphyria
b.      It does not trigger Malignant hyperthrermia"   Induction is rapid and recovery of consiousness after 4-7 minutes
c.       Post anaesthetic Performance of Mental, Manual and Mechanical task is back to normal within 1-2 hours
d.      Propofol is Suited for Day care Surgery
Comments
We have seen that Propofol is the Anaesthesia of choice in Day care anaesthesis. The other agents that are used are
1.         Alfentanyl
2.         Remifentanyl
3.         Isoflurane
4.         Sevoflurane
5.         Desflurane
6.         Methohexitone
7.         Thiopentone
8.         Etomidate
Tips
ü      Another recently described rare, but serious, side effect is propofol infusion syndrome. This potentially lethal metabolic derangement has been reported in critically-ill patients after a prolonged infusion of high-dose propofol in combination with catecholamines and/or corticosteroids. [Iwersen-Bergmann S, Rösner P, Kühnau HC, Junge M, Schmoldt A. Death after excessive propofol abuse. International Journal of Legal Medicine. 2001;114(4-5):248-51.]
ü      Abuse of propofol as a recreational drug has been reported, usually among medical staff such as anaesthesiologists who have access to the drug. Despite a lack of analgesic properties, propofol's sedative action presumably produces euphoric effects. The steep dose response curve of the drug makes such abuse very dangerous without proper monitoring, and several deaths have been recorded [Kranioti EF, Mavroforou A, Mylonakis P, Michalodimitrakis M. Lethal self administration of propofol (Diprivan). A case report and review of the literature. Forensic Science International. 2007 Mar 22;167(1):56-8. Epub 2006 Jan 23.]

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