To induce general anesthesia, propofol is the drug used nearly 100% of the time, and for maintenance of general anesthesia (in some cases), having largely replaced sodium thiopental. It can also be 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 or TCI. Propofol is also used to sedate individuals who are receiving mechanical ventilation but are not undergoing surgery, such as patients in the intensive care unit. In critically ill patients, propofol is superior to lorazepam both in effectiveness and overall cost. Propofol is relatively inexpensive compared to medications of similar use due to shorter ICU stay length. One of the reasons propofol is thought to be more effective (although it has a longer half-life than lorazepam) is because studies have found that benzodiazepines like midazolam and lorazepam tend to accumulate in critically ill patients, prolonging sedation.
Propofol is often used instead of sodium thiopental for starting anesthesia because recovery from propofol is more rapid and "clear." Propofol is very commonly used in the ICU as a sedation medication for intubated people. It can be run through a peripheral IV or central line. Propofol is frequently paired with fentanyl (for pain relief) in intubated and sedated people. Both are compatible in IV form.
Propofol is also used for procedural sedation. Its use in these settings results in a faster recovery compared to midazolam. It can also be combined with opioids or benzodiazepines. Because of its rapid induction and recovery time, propofol is also widely used for sedation of infants and children undergoing MRI. It is also often used in combination with ketamine with minimal side effects.
The Missouri Supreme Court decided to allow the use of propofol to execute prisoners condemned to death. However, the first execution by the administration of a lethal dose of propofol was halted on October 11, 2013, by governor Jay Nixon following threats from the European Union to limit the drug's export if it were used for that purpose.The United Kingdom had already banned the export of medicines or veterinary medicines containing propofol to the United States.
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