Propofol Infusion in Neurosurgery

Maintenance Anesthesia

The standard maintenance regimen for neurosurgical procedures involves a continuous infusion at 50-100 mcg/kg/min, which can be combined with short-acting opioids (such as fentanyl, alfentanil, sufentanil, or remifentanil) for analgesia during painful portions of surgery, as recommended by the World Journal of Emergency Surgery 1

Have vasopressors immediately available (such as ephedrine or metaraminol) to treat hypotension, and consider elevation of lower extremities or pressor agents when additional fluid therapy is contraindicated, according to Praxis Medical Insights 2

Combine propofol with short-acting opioids (such as fentanyl, alfentanil, sufentanil, or remifentanil) for analgesia during painful portions of surgery, as recommended by the World Journal of Emergency Surgery 1
Use processed EEG monitoring (BIS 40-60) to prevent awareness and avoid excessive depth, as suggested by Praxis Medical Insights 2

Propofol decreases cardiac output, systemic vascular resistance, and arterial pressure in a dose-dependent manner, according to the American Gastroenterological Association 3
Monitor heart rate, blood pressure, and pulse oximetry continuously, as recommended by the American Gastroenterological Association 3

Propofol decreases cardiac output, systemic vascular resistance, and arterial pressure in a dose-dependent manner, emphasizing the need for continuous monitoring of heart rate, blood pressure, and pulse oximetry in patients undergoing neurosurgery, as recommended by the American Society of Anesthesiologists 4
The use of propofol requires careful consideration of its potential to cause hypotension, and having vasopressors such as ephedrine or metaraminol immediately available is crucial, according to the American Heart Association 4

Avoid using propofol in patients with egg, soy, or sulfite allergies, as it can cause severe reactions, a precaution also advised by the American Academy of Allergy, Asthma, and Immunology 4

The American Society of Anesthesiologists recommends avoiding propofol in patients with egg, soy, or sulfite allergies, as propofol contains 10% soybean oil and 1.2% purified egg phosphatide 5
Propofol is not contraindicated in patients with sulfonamide allergy, according to the American Academy of Allergy, Asthma, and Immunology 5

The onset of action of propofol is 30-45 seconds, and the duration of effect is 4-8 minutes, as stated by the American Society of Anesthesiologists 5
Propofol's pharmacokinetics are not significantly affected by cirrhosis or renal failure, as reported by the National Institute of Diabetes and Digestive and Kidney Diseases 5

Pain on injection occurs in up to 30% of patients receiving intravenous bolus of propofol, according to the American Society of Regional Anesthesia and Pain Medicine 5
Co-administration of opioids and other CNS depressants potentiates propofol's sedative effect, as warned by the American Society of Anesthesiologists 5

Propofol causes dose-dependent decreases in cardiac output, systemic vascular resistance, and arterial pressure, as described by the American Heart Association 5
Propofol decreases cerebral blood flow, cerebral metabolic rate for oxygen, and intracranial pressure, making it suitable for neurosurgical procedures, as stated by the Congress of Neurological Surgeons 5

When using target-controlled infusion systems, the effect-site concentration for sedation should be 0.5-1 mcg/ml, and concentrations greater than 1.5 mcg/ml significantly increase the risk of over-sedation and hypoventilation, especially with concurrent opioids, according to the American Society of Anesthesiologists 6, 7
The European Society of Anaesthesiology recommends avoiding bolus dosing with target-controlled infusion systems to minimize the risk of over-sedation and respiratory depression 6, 7

The American Society of Anesthesiologists recommends a remifentanil combination with a target-controlled infusion effect-site concentration of 1-3 ng/ml for total intravenous anesthesia 6, 7
The European Society of Anaesthesiology suggests that fentanyl combination regimens should use bolus doses of 0.5-1 mcg/kg, with subsequent 0.5 mcg/kg doses as needed, to minimize the risk of respiratory depression 6, 7
The American Society of Anesthesiologists recommends an alfentanil combination with a bolus dose of 5 mcg/kg, and subsequent 1-3 mcg/kg doses as required, to achieve adequate analgesia 6, 7