Metabolic Profiles of Propofol and Fospropofol: Clinical and Forensic Interpretative Aspects
Table 1
Systemic therapeutic and adverse or side effects of propofol according to [2, 23–25].
Central Nervous System
(i) Depression with decrease in cerebral blood flow (CBF) and cerebral metabolic rate for oxygen (CMRO2) and intracranial pressure (ICP), which may be important in a patient with raised ICP (head trauma, cerebral neoplasia) (ii) Decrease of intraocular pressure (useful in glaucoma) (iii) In comparison to thiopental is more or at least equipotent as anticonvulsant in the treatment of epilepsy (iv) Excitatory phenomena, including muscle twitching and rigidity, paddling and opisthotonus, are occasionally seen at induction. These reactions are believed to be subcortical in origin and are usually transient and proper treatment is rarely required
Respiratory System
(i) Respiratory depression (including apnea) after an induction dose is the most common side effect and may affect the fetus or neonate if used on pregnant women (category C) (ii) Decrease both respiratory rate and tidal volume, resulting in a rise in arterial partial pressure of carbon dioxide (hypercapnia) and acidosis (iii) Hypoxia is also possible in the patient breathing room air (iv) Bronchospasm in patients with reactive airway disease
Cardiovascular System
(i) Greater decrease of blood pressure than other injectable anesthetics due to decreases in myocardial contractility and systemic vascular resistance without a compensatory rise in heart rate. It is thought that it impairs the baroreceptor response to low blood pressure (ii) Depression that may lead to hypotension and bradycardia due to vasodilatation (iii) Hypertriglyceridemia (>500 mg/dL) when infused for greater than 72 hours since lipid emulsion contains 0.1 g of fat/mL (iv) Phlebitis and thrombosis
Skeletal Muscle
(i) Myoclonus is occasionally seen but does not trigger malignant hyperthermia
Miscellaneous Effects
(i) Antimuscarinic or atropine-like syndrome (i.e., agitation, tachycardia, confusion, hallucinations) that can be reversed by physostigmine (ii) Pancreatitis (iii) Allergic reactions have not been reported (iv) Pain on intravenous injection site is common, a fact that can be minimized by using a large vein and by injecting a local anesthetic (e.g., lidocaine) (v) No significant endocrine effect, no change in the coagulation profile or platelet count and no significant effect on gastrointestinal motility (vi) May have antioxidant effects similar to vitamin E (vii) Decrease nausea and vomiting (viii) Propofol infusion syndrome (ix) Pruritus (x) Benign urine discoloration (xi) Reduce lymphocyte proliferation and inhibits phagocytosis in vitro (xii) Abuse
Precautions and Contraindications
(i) Elderly, hypovolemic and hypotensive patients (ii) Benzodiazepines and other central nervous depressants
