Propofol (2,6-diisopropylphenol) is the most widely used intravenous induction agent in modern anesthesia practice. Its favorable pharmacokinetic profile — rapid onset, short context-sensitive half-time, and minimal accumulation — makes it suitable for both induction and maintenance of anesthesia. Understanding its hemodynamic effects, dosing adjustments for special populations, and role in total intravenous anesthesia (TIVA) is essential for safe practice.
GABA-A receptor agonist with rapid onset (30–45 seconds) and short duration (5–10 minutes)
Induction dose: 1.5–2.5 mg/kg IV; reduced in elderly and hemodynamically compromised patients
TIVA infusion: 100–200 mcg/kg/min maintenance; titrate to clinical effect or BIS 40–60
Causes dose-dependent hypotension via decreased SVR and mild myocardial depression
Antiemetic properties at sub-hypnotic doses (10–20 mg IV bolus)
In hemodynamically unstable patients, reduce propofol induction dose to 0.5–1 mg/kg and administer slowly over 30–60 seconds. Consider etomidate or ketamine as alternatives when hemodynamic stability is the priority.
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