PROPOFOL - AN UPDATE OF ITS USE IN ANESTHESIA AND CONSCIOUS SEDATION

Propofol is an intravenous sedative hypnotic agent which rapidly and r eliably causes loss of consciousness. It is also associated with a qui ck and 'smooth' recover, which distinguishes it from many of the more traditional anaesthetic regimens. Like other intravenous agents, propo fol is both a cardiovascular and a respiratory depressant; however, th e risk of these effects can be lessened by appropriate dosage adjustme nt or patient management. Anaphylaxis with propofol is rare. Propofol anaesthesia in day case surgery is consistently associated with a quic ker early recovery than other intravenous agents and the more traditio nal anaesthetic regimens. Savings in time so discharge were more varia ble compared with these regimens, although propofol was commonly assoc iated with less post-operative nausea and vomiting in this period. In the future, the relative benefits of propofol compared with the newer volatile agents (desflurane and sevoflurane) and propofol/volatile age nt combinations need to be examined in this clinical setting. There is now clinical experience with propofol in major surgical procedures in cluding cardiac and neurosurgery. Propofol has also been investigated as a sedative accompanying regional or local anaesthesia for diagnosti c and therapeutic procedures, and in other clinical settings (ophthalm ic surgery, cardioversion and electroconvulsive therapy). The unique a ntiemetic, antiepileptic and antipruritic effects of propofol may furt her broaden its appeal. As a result of its favourable recovery profile , propofol holds a central place in day case surgery anaesthesia. Accu mulating clinical experience in cardiac and neurosurgery suggests that the full potential of propofol has yet to be realised.