Propofol is an intravenous anaesthetic which is chemically unrelated to other anaesthetics. Induction of anaesthesia with
propofol is rapid, and maintenance can be achieved by either continuous infusion or intermittent bolus
injections, with either
nitrous oxide or
opioids used to provide
analgesia. Comparative studies have shown
propofol to be at least as effective as
thiopentone,
methohexitone or
etomidate for anaesthesia during general surgery. The incidence of excitatory effects is lower with
propofol than with
methohexitone, but apnoea on induction occurs more frequently with
propofol than with other anaesthetics. Additionally, a small number of studies of induction and maintenance of anaesthesia have found
propofol to be a suitable alternative to induction with
thiopentone and maintenance with
halothane,
isoflurane or
enflurane.
Propofol is particularly suitable for
outpatient surgery since it provides superior operating conditions to
methohexitone (particularly less movement), and rapid recovery in the postoperative period associated with a low incidence of
nausea and
vomiting. When used in combination with
fentanyl or
alfentanil,
propofol is suitable for the provision of total intravenous anaesthesia, and comparative studies found it to be superior to
methohexitone or
etomidate in this setting. Infusions of subanaesthetic doses of
propofol have been used to sedate patients for surgery under regional anaesthesia, and also to provide sedation of patients in
intensive care. In the latter situation it is particularly encouraging that
propofol did not suppress adrenal responsiveness during short term studies. If this is confirmed during longer term administration this would offer an important advantage over
etomidate. Thus,
propofol is clearly an effective addition to the limited range of intravenous anaesthetics. While certain areas of its use need further study, as would be expected at this stage of its development,
propofol should find a useful role in anaesthetic practice.