Propofol: Expert Q&A

Posted: Sep 29, 2011 7:52 PM
Source: WebMD

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Propofol is a strong anesthetic that's used for surgery, some medical exams, and for sedation for people on ventilators -- never as a sleep aid. It's given by IV and should only be administered by a medical professional trained in its use. It takes effect in a matter of seconds.

"It is very fast-acting and works by slowing brain wave activities, says John F. Dombrowski, MD, an anesthesiologist/pain specialist at the Washington Pain Center in Washington, D.C.

Dombrowski, who is a board member of the American Society of Anesthesiologists, talked with WebMD about propofol's uses and abuses.

Does propofol have approved or off-label uses besides for surgical anesthesia?

No."I know of no off-label use or need for propofol," Dombrowski says. "It has a perfect place in the medical community, and that's in a surgical suite or ambulatory care setting."

Is it unusual for propofol to be used outside of a hospital setting?

"It's only to be used in a medical setting," Dombrowski says. "Outside of a hospital, it may be used in an ambulatory care center or a doctor's office, but only if it's administered by a trained professional, not by the doctor performing the procedure. You can't do your operation properly and do sedation at the same time. You can't serve two masters. That will lead to sloppy surgery or sloppy anesthesia care, and patients don't deserve that."

How dangerous is propofol?

Propofol is a potentially deadly drug in the wrong hands, and there is no room for error.

"It's only designed for people trained to do advanced cardiac life support," Dombrowski says. "It induces a deep level of sleep and sedation, and it can cause your blood pressure to go down and your breathing to stop. You can die. Patients have to be monitored beat by beat, minute by minute."

Can any doctor administer propofol, or is it more controlled?

"There's no DEA (Drug Enforcement Administration) licensing requirement, so the answer is no. It's not controlled and any physician can use it," Dombrowski says. "But I hope that physicians who are not trained to use it will have the insight to say, 'This is out of my comfort zone. What business do I have using this? None.'"

Can people get addicted to propofol? Is there any prolonged or repeated use of propofol?

"There's no data to support any addictive potential," Dombrowski says. "As for repeated uses, only if you are getting multiple procedures done. But there's no one out there saying, 'Hey, I'm going to get another hernia repair' just to get some propofol."

After someone has been on propofol and "wakes up," how would they feel? How different is it from sleep?

"You feel alert, unlike with [the anesthetic] pentothal, which left patients feeling really worn out and hungover," Dombrowski says."But while propofol induces sleep, it's not a clean, clear sleep."

Are there any statistics on propofol abuse?

"Abuse just doesn't occur, and if there's any abuse potential, it's so small that it's not enough to talk about," Dombrowski says."There's no access to it, and there's no reason someone would want it."

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