ํ๋กํฌํด
ํ๋กํฌํด์ ์ํจ์ฑ, ๊ณ ์ง์ฉ์ฑ ์ ๋งฅ ๋ง์ทจ์ ๋ก ์์ํ์์ ์ ์ ๋ง์ทจ์ ์ ๋ ๋ฐ ์ ์ง์ ๋๋ฆฌ ์ฌ์ฉ๋ฉ๋๋ค. ๋ฐํ์ด ๋น ๋ฅด๊ณ ํ๋ณต์ด ๋ถ๋๋ฌ์ ์ธ๋ ์ง๋จ์ด๋ ๊ฐ๋จํ ์์ ์ ํนํ ์ ์ฉํฉ๋๋ค. **์ฃผ์ ์์ ํน์ง:** * **๋น ๋ฅธ ๋ฐํ ๋ฐ ํ๋ณต:** 30-60์ด ๋ด์ ๋ง์ทจ๋ฅผ ์ ๋ํ๋ฉฐ, ์ค์ถ์ ๊ฒฝ๊ณ์์ ๋ค๋ฅธ ์กฐ์ง์ผ๋ก์ ์ฌ๋ถํฌ๋ก ์ธํด ํ๋ณต์ด ์ผ๋ฐ์ ์ผ๋ก ๋ถ๋๋ฝ๊ณ ๋น ๋ฆ ๋๋ค. * **์ฅ๊ธฐ ๊ธฐ๋ฅ:** ๊ฒฝ๋์์ ์ค๋ฑ๋์ ์ฌ์ฅ ์งํ, ๊ฐ ๋๋ ์ ์ฅ ์งํ์ด ์๋ ๋๋ฌผ์๊ฒ ์์ ํ๊ฒ ์ฌ์ฉํ ์ ์์ต๋๋ค. * **ํ๊ฐ ์ธ ์ฌ์ฉ:** ๋์น์ฑ ๋์ ์ฆ ์ง์์ํ์ ๋ํ ์ง์์ ์ ๋งฅ ์ฃผ์ (CRI)์ผ๋ก ์์ฃผ ์ฌ์ฉ๋๋ฉฐ, ํนํ ํํ ๋ฐ๋ฅด๋นํ์ด ๊ธ๊ธฐ์ธ ๊ฐ์ฑ ๋์ฆ ํ์์๊ฒ ์ ์ฉํฉ๋๋ค. * **๊ณ ์์ด ์ฃผ์์ฌํญ:** ๊ณ ์์ด๋ ๊ฐ์ ๊ฐ์ ๊ฐ๋ ฅํ ๊ธ๋ฃจ์ฟ ๋ก ์ฐ ํฌํฉ ๊ฒฝ๋ก๊ฐ ๋ถ์กฑํ์ฌ, ๋งค์ผ ์ฐ์ ์ฌ์ฉํ๊ฑฐ๋ ์ฅ๊ธฐ๊ฐ ์ฃผ์ ์ ํ๋ณต ์ง์ฐ, ํ์ธ์ฆ ์์ฒด ๋นํ ๋ฐ ๋ฌด๊ธฐ๋ ฅ์ฆ์ ์ทจ์ฝํฉ๋๋ค. > **์์ ์์ :** ํ๋กํฌํด์ **์งํต ํจ๊ณผ๊ฐ ์์ต๋๋ค**. ํต์ฆ์ ์ ๋ฐํ๋ ์์ ์ ๊ฒฝ์ฐ ์ ์ ํ ์์ ์ ํ ์งํต ํ๋กํ ์ฝ(์: ๋ง์ฝ์ฑ ์งํต์ , NSAID, ๊ตญ์ ๋ง์ทจ ์ฐจ๋จ)์ ๋ฐ๋์ ๋ณํํด์ผ ํฉ๋๋ค.
์์ฉ ๊ธฐ์ : While the monograph notes the mechanism is not well understood, **modern pharmacological consensus** indicates that propofol primarily acts as a positive allosteric modulator of inhibitory **GABA_A receptors** in the central nervous system. * **Mechanism:** Propofol binds to GABA_A receptors โ increases the inward conductance of chloride ions โ hyperpolarizes the postsynaptic neuronal membrane โ profound CNS depression and hypnosis. * **Cardiovascular & Respiratory:** Causes dose-dependent direct myocardial depression, vasodilation (arterial hypotension), and significant respiratory depression (apnea is common with rapid boluses). * **Other Effects:** Decreases intraocular pressure (IOP), possesses antiemetic properties, and at sub-anesthetic doses, can act as an appetite stimulant in dogs.
๋๋ฌผ ์ข ๋ณ ์ฉ๋
- Induction of general anesthesia (no premedication) ยท 4.1-8 mg/kg ยท IV ยท titrated ยท Mean induction dose 7.4 mg/kg.
- Induction of general anesthesia (with premedication) ยท 2.7-8 mg/kg ยท IV ยท titrated ยท Dose sparing effect of 16-24%.
- Maintenance of general anesthesia (no premedication) ยท 0.8-5 mg/kg ยท IV ยท intermittent ยท Duration of anesthesia following each dose is approx 3-5 minutes.
- Single injection induction (with acepromazine +/- butorphanol) ยท 4-6 mg/kg ยท IV ยท single dose ยท Doses of 8-13 mg/kg IV allow intubation without topical anesthesia.
- Induction of anaesthesia (unpremedicated) ยท 8 mg/kg ยท IV ยท single dose ยท as needed ยท Administer slowly over 30-60 seconds. Titrate to effect.
- Induction of anaesthesia (premedicated) ยท 2-5 mg/kg ยท IV ยท single dose ยท as needed ยท Administer slowly over 30-60 seconds. Titrate to effect.
- Maintenance of anaesthesia ยท 0.1-0.4 mg/kg/min ยท IV ยท CRI ยท as needed ยท Likely to result in a prolonged recovery in cats. Dose depends on other agents given in combination. Do not use benzyl alcohol formulations for CRI.
- Anesthesia (Rabbits) ยท 5-14 mg/kg slow IV (20 mg/kg/minute) to effect ยท IV ยท titrated ยท Not recommended as the sole agent for maintenance.
- Anesthesia (Mice) ยท 26 mg/kg ยท IV ยท single dose
ํฌ์ฌ ๊ฒฝ๋ก
๊ธ๊ธฐ
- Hypersensitivity to propofol or any component of the product
- Patients where general anesthesia or sedation is strictly contraindicated
- Use of benzyl alcohol-preserved formulations for maintenance of anaesthesia via continuous rate infusion (CRI)
์ด์๋ฐ์
- Transient respiratory depression and apnea (especially with rapid IV administration)
- Arterial hypotension and bradycardia
- Cyanosis (secondary to apnea)
- Seizure-like clinical signs during induction (paddling, opisthotonus, myoclonic twitching)
- Histamine release and rare anaphylactoid reactions
- Cats (with repeated/prolonged use): Heinz body anemia, slowed recovery, anorexia, lethargy, diarrhea
- Apnoea (especially with rapid injection)
- Cyanosis
- Bradycardia
- Severe hypotension
- Muscle rigidity and tremors (dogs)
- Paradoxical muscle movements (dogs)
- Heinz body anaemia (cats, with repeated daily use)
- Pain on IV injection
์ฝ๋ฌผ ์ํธ์์ฉ
- Inhalation Anesthetics (halothane, isoflurane) ยท Propofol serum concentrations may be increased; propofol induction may require higher initial inhalant concentrations due to rapid recovery.
- Local Anesthetics ยท Propofol dosage requirements for sedation or hypnosis may be reduced.
- Anticholinergics ยท Propofol-induced bradycardia may be exacerbated, particularly when opiate premedicants are used.
- Chloramphenicol ยท May decrease clearance of propofol and increase recovery times.
- Clonidine ยท When used as a premed, may reduce propofol dosage requirements.
- CNS Depressants (acepromazine, diazepam, etc.) ยท Increased sedative, anesthetic, and cardiorespiratory depression possible; propofol dose should generally be reduced by ~25%.
- Hepatic P-450 Inhibitors (cimetidine, ketoconazole) ยท May potentially increase recovery times associated with propofol (especially significant in cats).
- Fentanyl ยท Increased risk for bradycardia.
- Medetomidine ยท Hypoxemia may occur when propofol is used after medetomidine; dosage adjustments and adequate monitoring required.
- Metoclopramide ยท May reduce the propofol dose required for induction by 20-25%.
- Midazolam ยท Synergistic effects; midazolam plasma concentrations may be increased up to 20%.
๋ชจ๋ํฐ๋ง
- Level of anesthesia/CNS effects
- Respiratory rate, rhythm, and depth (monitor for apnea/cyanosis)
- Cardiovascular status (cardiac rate/rhythm, blood pressure, pulse oximetry)
- Respiratory rate, rhythm, and depth (capnography recommended)
- Heart rate and rhythm (ECG)
- Blood pressure
- Oxygen saturation (SpO2)
- Depth of anaesthesia
๊ณผ์ฉ๋
Overdosages are likely to cause **significant respiratory depression** (apnea) and potentially severe **cardiovascular depression** (hypotension, bradycardia). **Treatment:** 1. Immediately discontinue propofol administration. 2. Establish an airway and provide **artificial ventilation with 100% oxygen**. 3. Administer symptomatic and supportive treatment for cardiovascular depression (e.g., intravenous fluid therapy, vasopressors, anticholinergics like atropine or glycopyrrolate).
VetSheet ์ฝ๋ฌผ ๋ ํผ๋ฐ์ค๋ ๋ฉดํ ์์ ์ ๋ฌธ๊ฐ๋ฅผ ์ํ ์์ ์์ฌ๊ฒฐ์ ๋ณด์กฐ ๋๊ตฌ์ด๋ฉฐ, ์ ๋ฌธ์ ํ๋จ์ด๋ ์ ์กฐ์ฌ์ ์ต์ ๋ผ๋ฒจ์ ๋์ ํ์ง ์์ต๋๋ค.