Propofol

Propofol, marketed as Diprivan among other names, is a short-acting medication that results in a decreased level of consciousness and lack of memory for events. Its uses include the starting and maintenance of general anesthesia, sedation for mechanically ventilated adults, and procedural sedation. It is also used for status epilepticus if other medications have not worked. It is given by injection into a vein. Maximum effect takes about two minutes to occur and it typically lasts five to ten minutes. Common side effects include an irregular heart rate, low blood pressure, burning sensation at the site of injection, and the stopping of breathing. Other serious side effects may include seizures, infections with improper use, addiction, and propofol infusion syndrome with long-term use. It appears to be safe for using during pregnancy but has not been well studied in this group. However, it is not recommended during cesarean section. Propofol is not a pain medication, so opioids such as morphine may also be used. Whether or not they are always needed is unclear. Propofol is believed to work at least partly via a receptor for GABA. Propofol was discovered in 1977 and approved for use in the United States in 1989. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system. It is available as a generic medication. The wholesale price in the developing world is between 0.61 and 8.50 USD per vial. It has been referred to as milk of amnesia (a play on milk of magnesia) because of the milk-like appearance of the intravenous preparation. Propofol is also used in veterinary medicine for anesthesia. Propofol is used for induction and maintenance (in some cases) of general anesthesia, having largely replaced sodium thiopental. It can also be administered as part of an anesthesia maintenance technique called total intravenous anesthesia using either manually-programmed infusion pumps or computer-controlled infusion pumps in a process called target controlled infusion or TCI. Propofol is also used to sedate individuals who are receiving mechanical ventilation but are not undergoing surgery, such as patients in the intensive care unit. In critically ill patients, propofol has been found to be superior to lorazepam both in effectiveness and overall cost. Propofol is relatively inexpensive compared to medications of similar use due to shorter ICU stay length. One of the reasons propofol is thought to be more effective (although it has a longer half life than lorazepam) is because studies have found that benzodiazepines like midazolam and lorazepam tend to accumulate in critically ill patients, prolonging sedation.