PROPOFOL IN PATIENTS WITH CARDIAC DISEASE

Propofol is an intravenous anaesthetic which is chemically unrelated t o other iv anaesthetics. Most anaesthetists are now becoming familiar with propofol's pharmacokinetic and pharmacodynamic properties. It has proved to be a reliable drug that can be used safely for induction an d maintenance of anaesthesia for most surgical Procedures and unlike o ther anaesthetic agents, it can especially be extended into the postop erative setting or intensive care unit for sedation. Propofol's greate st attributes are its pharmacokinetic properties which result in a rap id, clear emergence and lack of cumulative effects even after prolonge d administration. Compared with other iv anaesthetics, the induction d ose of propofol has a relatively higher incidence Of respiratorY depre ssion, short-lived apnoea and blood pressure reduction that may occasi onally be marked. possible mechanisms for the hypotension may relate t o (1) its action on peripheral vasculature (vasodilatation), (2) decre ased myocardial contractility, (3) resetting of the baroreflex activit y and (4) inhibition of the sympathetic nervous system outflow. In vit ro studies indicate that propofol depresses the unmunological reaction to bacterial challenge as well as the chemotactic activity. Clinical studies, in cardiac surgery, have demonstrated that propofol, in assoc iation with an opioid, is a logical anaesthetic choice. Propofol is ab out to receive approval for continuous iv sedation. Comparative studie s of propofol and midazolam have clearly demonstrated the superiority of propofol in terms of rapid recovery and precise control of the leve l of sedation.