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Propofol

Dosierung/Anwendung:
  • iv induction: 1-2.5 mg/kg, 2-3 mg/kg in children (1)
  • iv maintenance infusion: 50-200 microg/kg/min (1)
  • Auf der Intensivstation wird - im Unterschied zum Operationssaal - nur die 2%-Propofol-Lösung verwendet. Dadurch entsteht eine nur halb so grosse Fettbelastung für den Patienten (2).
  • iv sedation infusion: 25-100 microg/kg/min (1), bzw. Boli von 10-20 mg und dann 1-3 mg/kg/h, unter Aufrechterhaltung der Spontanatmung (2); with TCI: initial target 0.5 mcg/ml, then wait an observe the clinical effect for a few minutes, adjustements in small steps (0.1-0.2 mcg/ml) (3).
  • If there is likely to be a delay between insertion of a venous canula and induction of anesthesia, it is worth starting at a low target concentration (0.5-1.5 mcg/ml) to provide some anxiolysis and to enable an assessment of the sensitivity of the patient to propofol. Start with 5-6 mcg/ml (6-8 mcg/ml in young patients; 4 mcg/ml in middle-aged or elderly patients). In general it may be wise, during a painful surgical procedure, to select an effect-site concentration target at least as high as that present during laryngoscopy (and even higher if there was a haemodynamic response during laryngoscopy. When the surgeon is starting to close the wound, reduce the target propofol concentration by ~25% (3).
  • "Roberts" manual regimen: 1 mg/kg bolus, followed by an infusion at 10 mg/kg/h for 10 minutes, then at 8 mg/kg/h for further 10 minutes, and finally at 6 mg/kg/h (3).
  • An anesthesist more familiar with the Schnider model will find that when the Marsh model is used, the larger initial bolus results in more rapid clinical effects (at a given target concentration) and may be associated with more severe adverse effects (3).
Interaktionen: Potenzierung der Propofolwirkung bei Kombination mit anderen zentral dämpfenden Medikamenten (2).

Unerwünschte Wirkungen (2): Dosen >3mg/kg/h in Spontanatmung sind potentiell gefährlich, weil das Risiko einer Hypoventilation bzw. Apnoe, aber auch eines Propofol-Infusionssyndroms (v.a. Dosen >= 5mg/kg/h während >= 72h) steigt.

Referenzen:
  1. Morgan & Mikhail's Clinical Anesthesiology. McGraw-Hill. 2013: p. 183.
  2. Delir und akute Erregungszustände auf der IDIS. Kantonsspital Olten. 19/10/2012.
  3. Anthony Absalom et al. An overview of TCI & TIVA. Academia Press. 2007:53-4.