Propofol Sedation in Elderly Patients - Uses and Pharmacological Effects

Creator: Dr. Kayathri P.
Published: 2023-03-21T18:26:26

4 min read

0

Share

Verified data

0

4 min read

Share

Propofol sedation in elderly patients should be administered at a reduced dosage. Read further to know why and also learn more about Propofol sedation.

Written by

Dr. Kayathri P.

Medically reviewed by

Dr. Rajesh Gulati

March 21, 2023

August 21, 2023

Contents

Share

Contents

Introduction:
What Is the Convenience of Using Propofol?
What Are the Pharmacological Effects of Propofol?
Can Propofol Be Used in the Elderly Population?
Conclusion:

Introduction:

Propofol is purely hypnotic (sleep-inducing), providing no analgesia (pain relieving) but moderate amnesia (memory loss). Propofol is considered an ideal anesthetic drug because it rapidly and smoothly induces anesthesia without causing problems like airway irritation and helps in rapid recovery. The mechanism of action of Propofol is likely the enhancement of GABA (gamma-aminobutyric acid)-induced chloride currents. However, it also has disadvantages like pain on injection, transient apnea (absence of breathing for short periods), involuntary movements, and hypotension (reduced blood pressure) after induction of anesthesia. The adverse effects of Propofol are overcome by coinduction with drugs like Midazolam, reducing the dose of Propofol.

What Is the Convenience of Using Propofol?

Propofol is a suitable agent for the induction and maintenance of anesthesia. Propofol has an anticonvulsant property and reduces intracranial pressure, which can be used as an advantage in the sedation of an epileptic patient. Epilepsy is a neurological disease in which there is an abnormal brain activity that elicits seizures for short periods of time and loss of awareness at times.
Propofol resulted in a much smoother awakening than Sevoflurane (an inhalational anesthetic agent).
Propofol, with the benefits of short duration and rapid titration, is a ubiquitous choice but may cause hypertriglyceridemia or, rarely, propofol infusion syndrome.
Hypertriglyceridemia refers to the excess concentration of a certain type of fat, triglycerides, in the blood. Propofol infusion syndrome is a serious complication associated with high doses and prolonged infusion duration that presents with metabolic acidosis, electrocardiogram (ECG) and conduction abnormalities, and rhabdomyolysis.
Metabolic acidosis refers to an electrolyte imbalance that causes too much acid production in the body. Rhabdomyolysis refers to the condition in which muscle tissue is broken down, and the contents are released into the blood.
EEG suppression is also achieved with clinically feasible doses of Propofol. A few physicians use it to provide protection during aneurysm surgery and carotid endarterectomy (CEA).
Aneurysm refers to the ballooning of the vessel wall of a blood vessel. Carotid endarterectomy is a surgical procedure to treat carotid artery disease by removing the excess plaque filled in the artery.
Propofol causes a dose-dependent decrease in arterial blood pressure and causes moderate respiratory depression.
A unique action of Propofol is its antiemetic effect (preventing nausea and vomiting), even at concentrations less than those producing sedation.
Evidence suggests Propofol may have antitumor potential.
In addition, Propofol sedation has been widely used during awake surgical resection of seizure foci (brain site from where the seizure originates) and other intracranial lesions. A high-amplitude beta-frequency activity in the EEG has been observed, but unexpected incidences of seizures have not been reported.

What Are the Pharmacological Effects of Propofol?

Effect on the Central Nervous System: Propofol produces hypnosis and also provides antiemetic action. It directly has a depressant effect on the neurons of the spinal cord. It also helps in preventing seizures. Hence they can be given to patients who are affected by seizures. Propofol decreases intracranial pressure in patients with normal or increased intracranial pressure.
Effect on the Respiratory System: Apnea (absence of breathing) occurs after the administration of Propofol. The incidence and duration of apnea depend on the dose, speed of injection, and the premedication given. Propofol-induced bronchodilation is seen in patients with COPD (chronic obstructive pulmonary disease).
Effect on the Cardiovascular System: The most prominent effect of Propofol is a decrease in arterial blood pressure during induction of Propofol. Heart rate is not significantly affected by Propofol induction.
Effect of Propofol on Sleep: The effect of Propofol on sleep architecture and REM (rapid eye movement) sleep is complex and dose-dependent. In long-term ventilated, critically ill patients, Propofol sedation abolishes REM sleep and diminishes sleep quality, whereas, with low-dose Propofol, REM sleep is possible. REM sleep is a phase during sleep that starts 90 minutes after the individual falls asleep. It is characterized by low muscle tone throughout the body, rapid movement of the eyes, and a tendency to dream.

Can Propofol Be Used in the Elderly Population?

The geriatric population has a number of major organ dysfunctions and associated diseases that will affect the pharmacokinetics and pharmacodynamics of the drugs. They also show increased sensitivity to surgical stimulation and central inhibitory drugs and exhibit alterations in hemodynamics like bradycardia (slow heart rate) and hypotension (reduced blood pressure). Propofol leads to limited cardiac contractility, leading to blood vessel dilation, reduced tension in blood vessels, and hypotension. According to a study, intravenous administration of Lidocaine during gastroscopy in older patients can reduce Propofol consumption. Through this, postoperative pain and incidence of hypoxia (reduced oxygen level in the tissues) are significantly reduced.

Propofol has been shown to induce hypotension in the geriatric population. For this purpose, a reduced dose of Propofol is preferred in the geriatric population. Studies have proven that the anesthetic drug delivery rate in the elderly population should be reduced. The recommended dose for an average person is in the range of two to four milligrams per hour. The maintenance rate of drug delivery should be reduced in the elderly population.

In procedures like gastrointestinal endoscopy combination of Midazolam with Propofol can be used since this combination has synergistic effects compared to using Propofol alone for sedation. By doing this, the Propofol dose is also significantly reduced. In the elderly population, preoxygenation followed by an initial bolus (single dose of drug administered in shorter periods of time) of fewer than 0.5 milligrams per kilogram followed by subsequent doses of 0.25 milligrams per kilogram is recommended.

Conclusion:

Anesthesia in elderly patients should be carefully assessed and appropriately administered during surgery to avoid possible complications that may endanger their lives. Propofol has been preferred due to its short duration of action, reduced postoperative nausea and vomiting, and promotes quicker recovery. The adverse effects of Propofol are overcome by coinduction with drugs like Midazolam, reducing the dose of Propofol. However, since it has adverse effects like hypotension in adults, it is necessary to pay attention while using it for the elderly population. A lower dosage of Propofol in the elderly population can maintain better anesthesia.

Frequently Asked Questions

1. What Are Some Common Side Effects of Propofol in the Elderly?

In the elderly, common side effects of Propofol include dizziness, nausea, and mild discomfort at the injection site. Additionally, changes in blood pressure and heart rate may occur during Propofol administration. Monitoring the elderly closely during the procedure and in the postoperative period is crucial to identify and manage any adverse reactions promptly. Proper dosage adjustments and medical supervision can help mitigate the risks associated with Propofol use in this age group.

2. Who Are Not Suitable Candidates for Propofol Administration?

Individuals who may not be suitable candidates for Propofol administration include those with a known allergy to Propofol or soybean/egg products, a history of severe allergic reactions to other medications, or a condition called porphyria. Additionally, patients with compromised cardiovascular function or respiratory issues may require careful consideration before administering Propofol due to its potential impact on these systems. It is essential for healthcare professionals to assess each patient's medical history and overall health status before deciding to use Propofol as an anesthetic agent.

3. What Are the Risk Factors Associated With Propofol Use?

Risk factors associated with Propofol use may include the patient's age and underlying health conditions. Elderly patients or those with cardiovascular or respiratory issues may be at higher risk for adverse reactions. Additionally, the dosage and rate of administration should be carefully controlled to avoid complications. Patients who have previously experienced allergic reactions to Propofol or related substances may also face an increased risk. Proper patient assessment and monitoring are essential to minimize potential risks during Propofol administration.

4. What Is the Protocol for Administering Propofol?

The protocol for administering Propofol involves a controlled and gradual infusion, typically through an intravenous (IV) line. The dosage and rate of administration should be tailored to the patient's age, weight, medical history, and anesthesia needs. Continuous monitoring of vital signs and the patient's level of sedation is essential throughout the procedure. An experienced anesthesia provider should oversee the administration to ensure safety and effectiveness.

5. Is There an Antidote Available for Propofol?

In cases of overdose or adverse reactions, the primary approach is supportive care, such as maintaining the patient's airway, circulation, and vital signs. The effects of Propofol are typically short-lived, and patients often recover spontaneously. However, any adverse reactions should be promptly reported to healthcare professionals for appropriate management. Always follow the guidance of healthcare providers when administering or managing Propofol-related incidents.

6. What Is the Recommended Safe Dosage Range for Propofol?

The recommended safe dosage range for Propofol can vary depending on the patient's age, weight, medical condition, and the type of procedure being performed. Typically, it is administered in a dose of 1 to 2.5 mg/kg for induction of anesthesia, followed by maintenance doses as needed. However, the exact dosage should be determined by an experienced anesthesia provider and adjusted accordingly to ensure the patient's safety and optimal sedation level throughout the procedure. Close monitoring of the patient's response and vital signs is essential when using Propofol.

7. How Much Propofol Can Be Safely Administered?

The safe amount of Propofol that can be administered varies based on individual factors, such as the patient's age, weight, medical condition, and the type of procedure being conducted. The dosage should be carefully calculated and administered by a qualified anesthesia provider to avoid complications. It is essential to adhere to recommended dosing guidelines and continuously monitor the patient's response and vital signs during Propofol administration. Avoiding excessive dosages is crucial to prevent potential adverse effects and ensure the patient's well-being.

8. In Which Situations Should Propofol Be Avoided?

Propofol should be avoided in patients with a history of hypersensitivity or allergic reactions to Propofol or any of its components. Additionally, individuals with a known allergy to soybean or egg products, which are present in the formulation, should not receive Propofol. Patients who have experienced severe adverse reactions to Propofol or those with certain medical conditions, such as porphyria, may also be unsuitable candidates for Propofol administration. It is crucial to thoroughly assess the patient's medical history and potential risks before considering Propofol as an anesthetic agent.

9. Does Propofol Have an Impact on Breathing?

Propofol administration may cause a transient decrease in breathing rate, and in some cases, it can lead to respiratory depression. Proper monitoring of the patient's respiratory status and vital signs is crucial during and after Propofol administration. Healthcare professionals should be prepared to provide respiratory support, especially in patients with pre-existing respiratory conditions or compromised lung function. The dosage and rate of Propofol infusion should be carefully adjusted to minimize the risk of respiratory side effects and ensure patient safety during the procedure.

10. Can Propofol Be Harmful to the Heart?

Propofol generally has minimal effects on the heart, and it is considered a relatively safe anesthetic agent for patients with a healthy cardiovascular system. However, in some cases, Propofol may cause a decrease in blood pressure, which can be concerning for individuals with pre-existing heart conditions. Healthcare providers should closely monitor blood pressure and heart rate during Propofol administration, especially in patients with cardiovascular issues. Proper dosage adjustments and vigilant monitoring can help mitigate any potential adverse effects on the heart and ensure patient safety.

11. What Is the Typical Duration of Action for Propofol?

The typical duration of action for Propofol is relatively short, usually lasting between five to 10 minutes. However, the duration may vary depending on factors such as the patient's age, weight, and individual response to the medication. Healthcare providers should closely monitor the patient during the procedure and be prepared to provide additional doses or adjust the anesthesia plan. After discontinuing Propofol, patients typically recover quickly, with the effects wearing off rapidly, allowing for a smoother emergence from anesthesia.

12. Can Patients Communicate While Under the Effects of Propofol?

Patients under the effects of Propofol are often sedated or in a state of anesthesia, which can lead to a reduced level of consciousness. While patients may occasionally make movements or utter sounds, meaningful communication is generally unlikely. The level of sedation induced by Propofol aims to prevent patients from feeling discomfort or remembering the procedure. Healthcare providers closely monitor patients' responses to ensure they remain safely sedated and comfortable throughout the procedure.

13. Why Is the Slow Injection of Propofol Recommended?

Propofol is typically injected slowly to reduce the risk of adverse effects, particularly related to cardiovascular and respiratory systems. Rapid administration of Propofol can lead to a sudden drop in blood pressure and cause respiratory depression. By administering it slowly, healthcare providers can closely monitor the patient's response and adjust the dosage as needed to maintain hemodynamic stability and ensure smooth induction of anesthesia. Slower injection also allows for better control over the sedation level and helps prevent complications associated with rapid changes in physiological parameters.

14. What Are the Reasons That Might Make Propofol Illegal in Certain Contexts?

It is a widely used anesthetic agent in medical settings for inducing anesthesia and sedation during various procedures. However, because of its potential for abuse and recreational use, Propofol is tightly regulated and strictly controlled by healthcare professionals. Its use outside of medical settings, without proper authorization, can lead to serious legal consequences due to the risks associated with misuse and the potential for harm to individuals not under proper medical supervision.

15. Does Propofol Affect Blood Pressure?

Propofol administration can cause a transient decrease in blood pressure due to its vasodilatory effects. In some cases, this can lead to hypotension, especially in patients with pre-existing cardiovascular issues. Healthcare providers closely monitor blood pressure during Propofol infusion and may adjust the dosage or provide supportive measures as needed. Adequate hydration and careful patient selection are essential to mitigate the risk of significant changes in blood pressure during Propofol administration.

Sources

Dr. Rajesh Gulati

Family Physician

Rate this article

Tags:

propofol

Do you have a question on

propofol

Ask a doctor online

*guaranteed answer within 4 hours

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.