PROPOFOL - THE IDEAL SEDATIVE FOR LONG-TE RM USE

Propofol is commercially available as Disoprivan(R). It is formulated as an aqueous emulsion with 1% 2,6-diisopropylphenol, 10% soya bean oi l, 2,5% glycerol and 1.2% egg phosphatide. Since 1986, propofol has be en used as a sedative drug in the ICU and is highly valued for its num erous positive qualities. High effectiveness is combined with excellen t control, which is demonstrably still present even after 2 weeks of s edation. This control enables shortterm neurological surveillance of t he patient and rapid weaning from the respirator once drug administrat ion is stopped. Propofol does not disturb cerebral autoregulation. Dep ression of spontaneous breathing facilitates the ventilation of intuba ted patients. As the solution contains lipids, it contributes to paren teral nutrition. All in all, ease of control and rapid response make p ropofol a highly valued product in ICUs. It is easy to understand why many ICU specialists consider propofol an ideal drug for long-term sed ation. The present authors, however, are convinced that certain limita tions must be taken into account. First, cardiovascular depression, es pecially if potentiated by drugs such as beta- and Ca-entry blockers, may lead to hypotensive episodes. Potential problems (drug tolerance, hypertriglyceridaemia) may be revealed in long-term studies. As long a s no such studies have been presented, the authors believe that it is too early to consider propofol the ideal drug for long-term sedation.