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To induce general anesthesia, propofol is the drug used almost exclusively, having largely replaced sodium thiopental. [13]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 [6] is a non-barbiturate derivative that is thought to act by stimulating inhibitory GABA receptors and blocking excitatory NMDA receptors. It takes 40 seconds for the effects of propofol to kick in, and effects last six minutes. [3] Propofol has both sedative and amnestic effects, but provides no analgesia.
Propofol-based TIVA significantly improves post-operative recovery profile and comfort, minimizes nausea and vomiting, facilitates rapid recovery, greater hemodynamic stability, preservation of hypoxic pulmonary vasoconstriction, reduction in intracerebral pressure, and reduces the risk of organ toxicity. [14]
Once they enter the circulatory system, the agents are transported to their biochemical sites of action in the central and autonomic nervous systems. Most general anaesthetics are intravenous or inhaled. Commonly used intravenous induction agents include propofol, sodium thiopental, etomidate, methohexital, and ketamine.
Propofol – It is a highly lipid-soluble, GABA agonist. [15] The dosage is 1.5 mg/kg (usually 100 to 200 mg). It has quick onset of action, can cross the blood-brain barrier, wide tissue distribution, and can be hepatically cleared by the body quickly. [15] In the elderly, the rate of Propofol clearance is low.
Twilight anesthesia is applied to various types of medical procedures and surgeries. It is a popular choice among surgeons and doctors who are performing anything from minor plastic surgeries to dental work, and procedures that do not require extensive operations or long durations in favor of less nausea and a limited recovery period after surgery.
Postanesthetic shivering is one of the leading causes of discomfort in patients recovering from general anesthesia. It usually results due to the anesthetic inhibiting the body's thermoregulatory capability, although cutaneous vasodilation (triggered by post-operative pain) may also be a causative factor.
Propofol infusion syndrome (PRIS) is a rare syndrome which affects patients undergoing long-term treatment with high doses of the anaesthetic and sedative drug propofol. It can lead to cardiac failure , rhabdomyolysis , metabolic acidosis , and kidney failure , and is often fatal.