Rationale for propofol use in cardiac surgery.

p ROPOFOL IS A COMMONLY USED intravenous anesthetic agent. Chemically, propofol is a lipophilic, sterically indered alkylated phenol that is a very weak acid.1,2 Pharmaokinetic and pharmacodynamic properties make propofol a seful drug in everyday anesthesia with rapid and clear emerence, precise control of the level of sedation, and lack of umulative effects even after prolonged administration.1-4 Alhough the terminal half-life of propofol is long, recovery is apid because of the slow mobilization from the highly liophilic tissue compartment.1-4 The indications for propofol use include the induction and aintenance of anesthesia for most surgical procedures, and it an be extended into the postoperative setting or intensive care nit for sedation. Rapid redistribution and elimination make ropofol valuable for short procedures and ambulatory surery.1-4 Moreover, the agent possesses antiemetic, antipruritic, nd anticonvulsant properties.1-4 Propofol is also widely used in subjects with cardiac disase.3,4 An anesthetic drug for cardiac surgery should provide ntraoperative amnesia, analgesia, and hemodynamic stability ith minimal direct myocardial depression and rapid recovery; deally, with weak inotropic support.4 Pharmacokinetic proprties of propofol favor its use in clinical practice in cardiac urgery patients.3-5 The induction of anesthesia with an opioidenzodiazepine/etomidate combination followed by a mainteance infusion of propofol supplemented with an inhalation gent or opioid analgesic or both as needed are considered cceptable for patients undergoing routine cardiac surgery.3 part from general anesthesia, major indications for propofol se are sedation during painful procedures (eg, cardioversion), ternal wound debridement, central venous catheter insertion, nd transesophageal echocardiography (Table 1).3,4 Propofol is safely administered to patients with cirrhosis and enal failure, with no impairment in its clearance.1 However, in omparison with other agents, the induction dose of propofol as a relatively higher prevalence of respiratory depression, hort-lived apnea, and arterial blood pressure (estimated even at