Prolonged Sedation With Propofol in Icu Patients: Recovery and Blood Concentration Changes During Periodic Interruptions in Infusion

Abstract

Propofol (mean dose 2.85 mg kg-1 h-1) was administered for 4 days by continuous i.v. infusion for sedation in 14 agitated and restless ICU patients. This provided rapid control of the level of sedation. When the infusion was discontinued, adequate recovery with response to commands was obtained in most patients by 10 min. Recovery times and the decrease in blood propofol concentration were similar after 24, 48, 72 and 96 h of infusion. Cumulative effects, tachyphylaxis, or other untoward effects were not observed.

Propofol in patients with cardiac disease

“…100.t2~, 122 The advantages of propofol are: (1) satisfactory level of sedation with minimal adjustment in the infusion rate, (2) adequate level of sedation reached rapidly, (3) cumulative effects, tachyphylaxis or other untoward effects are not observed, (4) recovery time and rate of decrease in blood propofol concentration after 24-96 hr of infusion are unchanged, (5) less analgesic was consumed, and (6) quicker return of spontaneous ventilation and more rapid tracheal extubation than after midazolam.…”

Prolonged Coma after Continuous Sedation with Propofol

“…However, administration of propofol for a similar length and dose as in our 2 patients did not lead to accumulation or complications in other reports [2, 4]. We did not monitor propofol blood levels but renal and hepatic functions were normal in both patients and no medications potentially inhibiting propofol metabolism were used.…”

“…Short acting agents, including propofol, have become widely used as they permit neurologic assessment shortly after discontinuation of sedation. Propofol levels rapidly decline due to redistribution [1]and recovery time even after prolonged use is usually between 10 and 30 min [2]. Prolonged coma without any neurologic sequel after administration of propofol has not been previously reported.…”

Propofol for Sedation and Control of Intracranial Pressure in Children

“…Like the barbiturates and benzodiazepines, it provides sedation and amnesia, but possesses no analgesic properties. Due to its rapid onset, rapid recovery time, and lack of active metabolites, it has become a popular agent for sedation in the adult ICU population [4, 5]. When compared with midazolam for sedation in adult patients, propofol has been shown to provide shorter recovery times, more rapid titration efficiency, reduced posthypnotic obtundation, and faster weaning from mechanical ventilation [4, 6].…”