Propofol is widely used for intravenous anesthesia. This drug causes rapid onset of drug-induced sleep. Our editors decided to find out what exactly made it such a popular anesthetic around the world.
Points of attention
- Propofol is the most controlled intravenous hypnotic from the point of view of pharmacokinetics, it is distinguished by the rapid onset of drug-induced sleep and a wide range of applications in anesthesiology.
- The mechanism of action of propofol is based on the activation of receptors in the brain, which leads to hyperpolarization of neurons and a decrease in their excitability, slowing down the transmission of interneuronal impulses.
- Dr. Barry Friedberg has developed his own method of anesthesia, which combines the main properties of intravenous and inhalation anesthesia.
- Propofol is the safest anesthetic, as confirmed by the results of brain monitoring and expressed in excellent effectiveness during medical procedures.
- Doctors recommend propofol as a safe and effective drug for anesthesia and sedation, which ensures high endoscopic success and avoids side effects.
What is known about propofol
The clinical use of propofol covers all branches of anesthesiology, especially sedation for diagnostic procedures, neuro anaesthesia, cardiac anaesthesia, and dental anaesthesia.
The main advantage of the drug is its rapid metabolism, which makes it the most controlled intravenous hypnotic from the point of view of pharmacokinetics.
Propofol was synthesised in the 1970s in the British company Imperial Chemical Industries laboratory. The first clinical studies were conducted in 1977. Then, the possibility of using propofol as a short-term anaesthesia was demonstrated for the first time. Immediately, some researchers began to position it as the "ideal intravenous anaesthetic".
The drug's mechanism of action involves activating certain receptors in the brain through the activation of chlorine ion channels. As a result, neurons hyperpolarise, their excitability decreases, and the transmission of interneuronal impulses slows down. This causes the onset of an anaesthetic and soothing effect.
In 1985, propofol was first used to treat children. In 1989, propofol was registered for clinical use in the United States and included in the list of essential medicines of the World Health Organisation (WHO).
Propofol combines the main properties of intravenous and inhalation anaesthesia. It allows one to fall asleep quickly and restore protective reflexes after anaesthesia.
Anesthesia methods of Dr. Friedberg
Dr Friedberg developed his method of anaesthesia, which does not threaten the health and life of the brain, prevents excessive postoperative pain and does not cause nausea in patients.
Dr Barry Friedberg is a qualified anesthesiologist with 30 years of experience and the author of the science-based book Getting Over Going Under, dedicated to new anaesthesia practice techniques.
Dr. Friedberg actively promotes propofol in his scientific works and reports. In 1992, he began using propofol-ketamine, a simple, intermediate alternative to general anaesthesia. This option has become ideal for planned cosmetic surgery.
Brain monitoring is the standard of anesthesia in the 21st century, and propofol is the safest anesthetic, Dr. Friedberg emphasizes.
He became the first anesthesiologist in California (USA) to regularly use BIS monitoring, which measures the depth of sedation during drug-induced sleep. This monitoring allows the anesthesiologist to dose anaesthetics and drugs that induce medical sleep most accurately.
It is worth noting that in the period from 1992 to 2018, none of the more than 5,000 patients who received gradual induction with propofol required endotracheal intubation.
What could save Michael Jackson?
One of the chapters of Dr. Friedberg's book Getting Over Going Under is devoted to the death of legendary musician Michael Jackson. After all, propofol was used in the investigation of this tragedy. The executor's doctor, in particular, brought the charges.
Dr. Friedberg claims that the dosage of propofol did not matter because the only thing that was important to the patient's life was the monitoring of his condition. When using propofol, the most frequent side effects are arterial hypotension, bradycardia, and depression of spontaneous breathing.
Therefore, the effect of propofol on Michael Jackson's brain had to be controlled by a doctor through appropriate monitors, which was not done.
In his book, Dr. Friedberg wrote: “What could have prevented Jackson's death? A competent, conscious specialist who would simultaneously monitor the patient and control oxygen is the minimum he should have done without fail. A brain activity monitor would monitor the effects of propofol and thus prevent Michael Jackson from stopping breathing."
Reviews of doctors about propofol
In the West, anaesthesia or sedation is performed in outpatient settings by anesthesiologists, nurse anaesthetists, and doctors of similar specialities — dentists, endoscopists, etc.
In Germany, propofol was approved in 1996. Doctors emphasize that the drug has a narrow therapeutic range. This means that, in fact, gastroenterologists need the help of an anesthesiologist, who must monitor the patient's blood pressure and breathing.
In particular, the leading specialist in anesthesiology, the director of the clinic in Heilbronn (Germany), Dr Uwe Schulte-Sasse, emphasises that an anesthesiologist should handle anaesthesia. Regarding propofol, he adds: "A colonoscopy requires maximum concentration. A doctor cannot also perform the work of an anesthesiologist."
Anesthesiologist of the highest category, Roman Olefirenko, who has been successfully working with propofol in Ukraine for more than 20 years, notes that the peculiarity of the drug, in his opinion, is that it almost does not anaesthetise the patient but only provides sleep. Also, this drug does not cause addiction. That is, it can be used for patients who even have addictions of a narcotic nature.
Doctor Jonathan D. Kaunitz from Santa Monica (USA) also favours the drug: "Using propofol, the endoscopist can perform the examination faster, more carefully and thoroughly. Thus, many practitioners choose propofol because it makes economic and medical sense."
For example, endoscopic retrograde cholangiopancreatography (ERCP) in Great Britain is performed under sedation.
Therefore, given the increasing number of cases, the role of ERCP (combination of endoscopy with radiological examination) with propofol has increased.
British doctors conclude that propofol is safe and associated with high endoscopic success.
The editors prepared this material using open sources. This article was not written with advertisement goals. We remind you that self-medication can be harmful to your health.
