Are you going to use propofol?

One of the questions we are frequently asked by patients is what type of medications they will be getting during their procedure. Often the answer includes mentioning propofol, or Diprivan, which is the brand name. When some patients hear that they let out a nervous laughter, which is followed by another question: “Isn’t that the same stuff Michael Jackson used?”

“Yes,” I reply. Propofol is used very commonly in many anesthetics and, in the hands of an experienced anesthesiologist, is safe.

The sedative properties of propofol take effect and wear off quickly, which makes it a good choice for outpatient anesthesia for procedures in gastroenterology and dentistry. The medication can be titrated to cause what is commonly known as minimal, moderate, and deep sedation and general anesthesia. Patients report a sense of well-being upon awakening as though they had restful sleep. It also works as an anti-emetic medication to treat nausea or vomiting, which may occur after general anesthesia. If propofol is given as the primary anesthetic, most patients do not experience nausea or vomiting.

Propofol has a sound safety profile, particularly when used by the appropriate healthcare professional where emergencies can be addressed quickly. The concerns of using it:

• may cause pain on injection, but this can be managed with other medications;
• contains sodium sulfide and egg phosphatide, which may cause an allergic reaction in patients sensitive to sulfite or eggs, respectively, but these do not appear to be clinically significant;
• is prepared as a fat emulsion which contributes to the growth of microorganisms and contamination can result but is not a serious problem if it is not used after its expiration time or shared between patients;
• causes cardiovascular and respiratory depression but can be managed by the anesthesiologist; and
• may cause propofol infusion syndrome, which is a constellation of conditions including cardiac and kidney failure but is most common if used in high doses over long periods of time.

There are several major differences to the anesthesiologist’s use of propofol in an outpatient setting compared to that in a home for so-called off-label usage for anxiety or insomnia, or sleeping problems. We use propofol in a setting that is equipped with necessary and backup equipment including oxygen and multiple devices to administer this medication safely.

Other differences are that we:

• use propofol every day for a very brief period of time for patients–only as long as it takes to do the procedure–which is typically no more than a few hours;
• monitor our patients for cardiac, circulatory, and respiratory functions, which include auscultation, or listening, of heart and breath sounds, pulse oximetry for measuring oxygen saturation, capnography to confirm ventilation, electrocardiogram, blood pressure, and temperature;
• administer propofol with an infusion pump, which gives us computer-like precision to give just enough necessary for the patient and no more; and
• are by the patient’s side at all times and often stand in order to increase our situational awareness and give our undivided attention.

There are alternatives to the use of propofol. Please feel free to contact us to discuss this medication further or to request alternatives to propofol.

References

1. Barash P, Cullen B, Stoelting R, et al., eds. Clinical Anesthesia. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins.

2. Death Certificate for Michael Jackson, 25 June 2009, File No. 3052009085414, Los Angeles County Department of Health Services.

3. Miller RD, Eriksson LI, Fleisher L, et al., eds. Miller’s Anesthesia. 7th ed. Philadelphia, PA: Churchill Livingstone.

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We are physician anesthesiologists (medical doctor / MD) who provide anesthesia to individuals with a phobia, fear, and anxiety for outpatient procedures in fields such as dermatology, plastic surgery, gastroenterology (upper gastrointestinal endoscopy, esophagogastroduodenoscopy, EGD, colonoscopy, otolaryngology (ear, nose, throat / ENT), and dentistry (deep cleaning, implant, all-on-four, root canal, and wisdom teeth extraction).

We provide various levels of anesthesia–from monitored anesthesia care (MAC) to general anesthesia. MAC is often used interchangeably with conscious sedation and twilight anesthesia. As it relates to dentistry, it is referred to as sleep dentistry, sedation dentistry, dental anesthesia, and intravenous, or IV, sedation.

We practice in Northern (Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, Solano, and Sonoma counties) and Southern (Los Angeles, Orange, San Bernardino, Riverside, Ventura, and San Diego counties) California.

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