Propofol (DB00818): A Comprehensive Clinical and Pharmacological Monograph

Introduction

Propofol, chemically identified as 2,6-diisopropylphenol, is a short-acting, intravenously administered hypnotic agent that has become a cornerstone of modern anesthetic practice.[1] Since its widespread introduction, it has fundamentally reshaped the landscape of anesthesia, primarily due to a highly favorable pharmacokinetic profile characterized by rapid and smooth induction of anesthesia, predictable dose-dependent effects, and a clear-headed, swift recovery.[3] These properties have been instrumental in facilitating the global expansion of ambulatory (day-case) surgery and have established propofol as the principal agent for total intravenous anesthesia (TIVA) techniques.[4] Its utility extends beyond the operating room to procedural sedation and the sedation of critically ill patients in the intensive care unit (ICU).[3]

This clinical versatility, however, is balanced by a significant and demanding risk profile. Propofol possesses a narrow therapeutic window, meaning the dose required for sedation is close to that which can cause profound, life-threatening cardiorespiratory depression, including hypotension, apnea, and loss of protective airway reflexes.[9] This inherent risk is compounded by the lack of a specific pharmacological reversal agent, mandating its administration by personnel expertly trained in general anesthesia and advanced airway management.[12] Furthermore, its lipid emulsion formulation creates a potential vector for microbial contamination if strict aseptic technique is not followed.[3] The drug also carries a potential for abuse, particularly among healthcare professionals, and is associated with the rare but often lethal complication of Propofol Infusion Syndrome (PRIS) when used at high doses or for prolonged periods.[12]