Table 2.

Propofol
Group	Phenol Derivative
Mechanism of Action/Pharmakodynamics	Potentiation GABAA receptors Na+ channel blocker
Neuroprotective effects	Reduces CBF, CMRO2 and ICP Reduces MAP, therefore variable effect on CPP Increases seizure threshold
Pharmacokinetics	Rapid hepatic metabolised, with extra-hepatic metabolism t 1/2 2–24 hours, but rapid peripheral distribution Short context sensitive t 1/2
Advantages	Favourable effects on CBF, CMRO2 and ICP Rapid onset of action Relatively short context sensitive t 1/2 facilitating neurological assessment
Disadvantages and major side effects	Hypotension may worsen CPP High lipid load Associated with elevated liver enzymes & pancreatitis Potential for PRIS, particularly with prolonged, high dose infusions Formulation may support bacterial and fungal growth Contraindicated if allergic to egg or soybeans
Dosage	Induction: 1–2.5 mg/kg, 0.5–1.5 mg/kg in elderly or limited cardiovascular reserve Maintenance of sedation: 1.5–4.5 mg/kg/hour, titrated to desired effect
Other significant facts	Increased risk of PRIS at infusions >4 mg/kg/h for >48 h
Appropriate roles in TBI	Induction agent, caution in hypotension Continuous infusion to provide sedation in TBI Refractory elevated ICP Refractory seizures