Anesthesia To induce general anesthesia, propofol is the drug used almost exclusively, having largely replaced
sodium thiopental. It is often administered as part of an anesthesia maintenance technique called
total intravenous anesthesia, using either manually programmed infusion pumps or computer-controlled infusion pumps in a process called
target controlled infusion (TCI). Propofol is also used to sedate people who are receiving mechanical ventilation but not undergoing surgery, such as patients in the
intensive care unit. In critically ill patients, propofol is superior to
lorazepam both in effectiveness and overall cost. Propofol is relatively inexpensive compared to medications of similar use due to shorter ICU stay length. The two drugs are molecularly compatible in an IV mixture form.
Routine procedural sedation Propofol is safe and effective for gastrointestinal endoscopy procedures (colonoscopies etc.). Its use in these settings results in a faster recovery compared to
midazolam. It can also be combined with
opioids or
benzodiazepines. Because of its rapid induction and recovery time, propofol is also widely used for sedation of infants and children undergoing
MRI procedures. It is also often used in combination with
ketamine with minimal side effects.
COVID-19 In March 2021, the U.S.
Food and Drug Administration (FDA) issued an
emergency use authorization (EUA) for
Propofol‐Lipuro 1% to maintain sedation via continuous infusion in people older than sixteen with suspected or confirmed COVID-19 who require mechanical ventilation in an
intensive care unit ICU setting. During the public health emergency, it was considered unfeasible to limit Fresenius Propoven 2% Emulsion or Propofol-Lipuro 1% to patients with suspected or confirmed COVID-19, so it was made available to all ICU patients under mechanical ventilation.
Status epilepticus Status epilepticus may be defined as seizure activity lasting beyond five minutes and needing anticonvulsant medication. Several guidelines recommend the use of propofol for the treatment of refractory status epilepticus.
Other uses Assisted death in Canada A lethal dose of propofol is used for
medical assistance in dying in Canada to quickly induce deep coma and death, but
rocuronium is always given as a
paralytic ensuring death, even when the patient has died as a result of initial propofol overdose.
Capital punishment The use of propofol as part of an execution protocol has been considered, although no person has been executed using this agent. This is largely due to European manufacturers and governments banning the export of propofol for such use.
Recreational use Recreational use of the drug via self-administration has been reported but is relatively rare due to its potency and the level of monitoring required for safe use. Critically, a steep
dose-response curve makes recreational use of propofol very dangerous, and deaths from self-administration continue to be reported. The short-term effects sought via recreational use include mild euphoria, hallucinations, and disinhibition. Recreational use of the drug has been described among medical staff, such as
anesthetists who have access to the drug. It is reportedly more common among anesthetists on rotations with short rest periods, as usage generally produces a well-rested feeling. Long-term use has been reported to result in addiction. Attention to the risks of
off-label use of propofol increased in August 2009, after the release of the Los Angeles County coroner's report that musician
Michael Jackson was
killed by a mixture of propofol and the
benzodiazepine drugs
lorazepam,
midazolam, and
diazepam on 25 June 2009. According to a 22 July 2009 search warrant affidavit unsealed by the district court of Harris County, Texas, Jackson's physician,
Conrad Murray, administered 25 milligrams of propofol diluted with
lidocaine shortly before Jackson's death. ==Manufacturing==