Describe the pharmacology of propofol

[Click here to toggle visibility of the answers]

College Answer

A structured approach proved a good basis to answer this question. It was expected candidates
would outline the uses such as anaesthesia, more prolonged sedation or possible additional
roles in patients with seizures or head injuries. Discussion of the presentation and
pharmaceutics, including a comment on antibacterial preservatives or lack thereof was
expected. The mechanism of action should have been described. It was expected candidates
could provide an indication of the usual dose (and how it differs in the more unwell / elderly
patient population). A maximal rate and possible toxicity was expected.

A discussion on the pharmacodynamics by major organ systems was expected and credit was
given for additional comments about hyperlipidaemia, urine colour changes or metabolic
alterations. It was expected that candidates would mention propofol infusion syndrome at some
point in their answer with some mention of clinical features or pathophysiology.

The important aspects of its pharmacokinetics should have been mentioned (high protein
binding, large volume of distribution, termination of effect by redistribution, hepatic metabolism,
context sensitive half life). A mention of adverse effects would complete the answer.