Safety and side effects of propofol in clinical practice - literature overview
DOI:
https://doi.org/10.12775/JEHS.2023.38.01.017Keywords
propofol, propofol bradycardia, propofol infusion pain, propofol hypotension, propofol neuroprotection, propofol infusion syndromeAbstract
Introduction and purpose
Since people have been conducting surgeries to improve their health, they have always faced the problem of pain that these actions inevitably bring. Propofol as an anesetic is one of the solutions to these problems. Due to the widespread use of this drug, its side effects are often observed. This paper aims to gather the available knowledge about the adverse reactions of propofol in clinical practice and to present ways to reduce the risk of their occurrence described in the literature.
Material and methods
The following review of the work was based on viewable data obtained from the PubMed database and Google Scholar. The key words used in the search were: propofol, propofol infiusion syndrome, propofol bradycardia, propofol infusion pain, propofol neuroprotection, propofol hypotension.
Conclusions
Studies indicate a number of possible solutions to reduce the risk or intensity of individual side effects. . There are many possibilities, both pharmacological and non-pharmacological, fulfilling this task – administration of propofol simultaneously with drugs of other groups responsible for sedation, replacement of propofol with another sedation drug in selected situations, cold compresses, analgetic usage of vibrations. These methods require further research and the development of appropriate protocols for use in clinical situations.
References
Walsh CT. Propofol: milk of amnesia. Cell [Internet]. September 2018;175(1):10-3. Available in: https://doi.org/10.1016/j.cell.2018.08.031
Moos DD. Propofol. Gastroenterol Nurs [Internet]. March 2006;29(2):176-8. Available in: https://doi.org/10.1097/00001610-200603000-00097
Sun B, Ou H, Ren F, Huan Y, Zhong T, Gao M, Cai H. Propofol inhibited autophagy through Ca2+/CaMKKβ/AMPK/mTOR pathway in OGD/R-induced neuron injury. Mol Med [Internet]. 23 November 2018;24(1). Available in: https://doi.org/10.1186/s10020-018-0054-1
Singh A, Anjankar AP. Propofol-Related infusion syndrome: a clinical review. Cureus [Internet]. 17 October 2022. Available in: https://doi.org/10.7759/cureus.30383
Li WK, Chen XJ, Altshuler D, Islam S, Spiegler P, Emerson L, Bender M. The incidence of propofol infusion syndrome in critically-ill patients. J Crit Care [Internet]. October 2022;71:154098. Available in: https://doi.org/10.1016/j.jcrc.2022.154098
Hausburg MA, Banton KL, Roman PE, Salgado F, Baek P, Waxman MJ, Tanner A, Yoder J, Bar-Or D. Effects of propofol on ischemia-reperfusion and traumatic brain injury. J Crit Care [Internet]. April 2020;56:281-7. Available in: https://doi.org/10.1016/j.jcrc.2019.12.021
Hemphill S, McMenamin L, Bellamy MC, Hopkins PM. Propofol infusion syndrome: a structured literature review and analysis of published case reports. Br J Anaesth [Internet]. April 2019;122(4):448-59. Available in: https://doi.org/10.1016/j.bja.2018.12.025
Shimizu J, Tabata T, Tsujita Y, Yamane T, Yamamoto Y, Tsukamoto T, Ogawa N, Kim H, Urushitani M, Eguchi Y. Propofol infusion syndrome complicated with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke‐like episodes: a case report. Acute Med Amp Surg [Internet]. 4 December 2019;7(1). Available in: https://doi.org/10.1002/ams2.473
Mirrakhimov AE, Voore P, Halytskyy O, Khan M, Ali AM. Propofol infusion syndrome in adults: a clinical update. Crit Care Res Pract [Internet]. 2015;2015:1-10. Available in: https://doi.org/10.1155/2015/260385
Ayele T, Ezeh E, Al-Qawasmi L, Ugonabo OS, Saylor J, Dial L. Diagnosed by reversibility: unmasking propofol-related infusion syndrome in a critically-ill elderly male. Cureus [Internet]. 26 March 2022. Available in: https://doi.org/10.7759/cureus.23504
Honore PM, Spapen HD. Propofol infusion syndrome: early blood purification to the rescue? Crit Care [Internet]. 4 July 2016;20(1). Available in: https://doi.org/10.1186/s13054-016-1364-8
Tramèr MR, Moore RA, McQuay HJ. Propofol and bradycardia: causation, frequency and severity. Br J Anaesth [Internet]. June 1997;78(6):642-51. Available in: https://doi.org/10.1093/bja/78.6.642
Jakob SM. Dexmedetomidine vs midazolam or propofol for sedation during prolonged mechanical ventilation. Jama [Internet]. 21 March 2012;307(11):1151. Available in: https://doi.org/10.1001/jama.2012.304
Brotherton AL, Hamilton EP, Kloss HG, Hammond DA. Propofol for treatment of refractory alcohol withdrawal syndrome: a review of the literature. Pharmacotherapy [Internet]. April 2016;36(4):433-42. Available in: https://doi.org/10.1002/phar.1726
Yao Y, Guan J, Liu L, Fu B, Chen L, Zheng X. Discharge readiness after remimazolam versus propofol for colonoscopy. Eur J Anaesthesiol [Internet]. 6 July 2022; Publish Ahead of Print. Available in: https://doi.org/10.1097/eja.0000000000001715
Liu Y, Yu X, Zhu D, Zeng J, Lin Q, Zang B, Chen C, Liu N, Liu X, Gao W, Guan X. Safety and efficacy of ciprofol vs propofol for sedation in intensive care unit patients with mechanical ventilation. Chin Med J [Internet]. 16 December 2021; Publish Ahead of Print. Available in: https://doi.org/10.1097/cm9.0000000000001912
Xin N, Yan W, Jin S. Efficacy of analgesic propofol/esketamine and propofol/fentanyl for painless induced abortion: a randomized clinical trial. BioMed Res Int [Internet]. 9 June 2022; 2022:1-6. Available in: https://doi.org/10.1155/2022/5095282
Zhang R, Lu Q, Wu Y. The comparison of midazolam and propofol in gastrointestinal endoscopy. Surg Laparosc Endosc Amp Percutaneous Tech [Internet]. May 2018 Available in: https://doi.org/10.1097/sle.0000000000000532
Edokpolo LU, Mastriano DJ, Serafin J, Weedon JC, Siddiqui MT, Dimaculangan DP. Discharge readiness after propofol with or without dexmedetomidine for colonoscopy. Anesthesiology [Internet]. 1 August 2019;131(2):279-86. Available in: https://doi.org/10.1097/aln.0000000000002809
Schonberger RB, Dai F, Michel G, Vaughn MT, Burg MM, Mathis M, Kheterpal S, Akhtar S, Shah N, Bardia A. Association of propofol induction dose and severe pre-incision hypotension among surgical patients over age 65. J Clin Anesthesia [Internet]. September 2022;80:110846. Available in: https://doi.org/10.1016/j.jclinane.2022.110846
Sneyd JR, Absalom AR, Barends CR, Jones JB. Hypotension during propofol sedation for colonoscopy: a retrospective exploratory analysis and meta-analysis. Br J Anaesth [Internet]. April 2022;128(4):610-22. Available in: https://doi.org/10.1016/j.bja.2021.10.044
Sekiguchi R, Kinoshita M, Kawanishi R, Kakuta N, Sakai Y, Tanaka K. Comparison of hemodynamics during induction of general anesthesia with remimazolam and target-controlled propofol in middle-aged and elderly patients: a single-center, randomized, controlled trial. BMC Anesthesiol [Internet]. 10 January 2023;23(1). Available in: https://doi.org/10.1186/s12871-023-01974-9
Ji L, Sun W, Lan Y, Xia C, Yu G, Wu Q, Yang S, Xu X. Dexmedetomidine for prevention of propofol injection pain upon induction of anesthesia: a meta-analysis. Eur J Clin Pharmacol [Internet]. 8 May 2020;76(8):1103-10. Available in: https://doi.org/10.1007/s00228-020-02889-x
Wang W, Wu L, Zhang C, Sun L. Is propofol injection pain really important to patients? BMC Anesthesiol [Internet]. 17 February 2017;17(1). Available in: https://doi.org/10.1186/s12871-017-0321-7
Guan X, Jiao Z, Gong X, Cao H, Liu S, Lan H, Huang X, Tan Y, Xu B, Lin C. Efficacy of pre-treatment with remimazolam on prevention of propofol-induced injection pain in patients undergoing abortion or curettage: a prospective, double-blinded, randomized and placebo-controlled clinical trial. Drug Des Dev Ther [Internet]. October 2021;Volume 15:4551-8. Available in: https://doi.org/10.2147/dddt.s334100
Bakhtiari E, Mousavi SH, Gharavi Fard M. Pharmacological control of pain during propofol injection: a systematic review and meta-analysis. Expert Rev Clin Pharmacol [Internet]. 1 June 2021;14(7):889-99. Available in: https://doi.org/10.1080/17512433.2021.1919084
Wang W, Zhou L, Wu LX, Wang T, Zhang CB, Sun L. 5-HT3 receptor antagonists for propofol injection pain: a meta-analysis of randomized controlled trials. Clin Drug Investig [Internet]. 10 February 2016;36(4):243-53. Available in: https://doi.org/10.1007/s40261-016-0375-1
Karki Y, Sarna R, Singh N, Chauhan R, Meena SC, Luthra A, Thappa P. Prevention of pain on injection of propofol using ice gel pack versus pre-treatment with lignocaine: a randomized controlled trial. J Anesthesia [Internet]. 14 June 2023. Available in: https://doi.org/10.1007/s00540-023-03216-1
Hwang LK, Nash DW, Yedlin A, Greige N, Larios-Valencia J, Choice C, Pothula A. The effect of vibration on pain during intravenous injection of propofol. Ann Plast Surg [Internet]. 18 March 2021;Publish Ahead of Print. Available in: https://doi.org/10.1097/sap.0000000000002827
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Maciej Lambach, Gabriela Demidowicz, Natalia Trąbka, Klaudia Kowalczyk, Nina Lasota, Wojciech Wiśniewski, Małgorzata Chyćko, Julia Czarnota, Katarzyna Cichoń, Martyna Younes
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 393
Number of citations: 0