Lipuro Emulsion for infusion

Introduction

Lipuro Emulsion for infusion 200 mg/20 ml is a general anesthetic used for the induction and maintenance of anesthesia during surgical procedures and for sedation in intensive care units (ICUs). It is known for its rapid onset and short duration of action, making it a preferred choice for short-term anesthesia and sedation.

Uses

Lipuro Emulsion for infusion 200 mg/20 ml is used for:

Induction and maintenance of general anesthesia during surgical and diagnostic procedures.
Sedation of patients undergoing mechanical ventilation in an ICU setting.
Procedural sedation for minor procedures and examinations.

Brand Name	Lipuro
Type	Emulsion for infusion
Weight	200 mg/20 ml
Generic	Propofol
Manufacturer	B. Braun Melsungen AG, Germany
Available in	English বাংলা

Mechanism of Action

Lipuro Emulsion for infusion 200 mg/20 ml works by enhancing the activity of gamma-aminobutyric acid (GABA) at the GABA-A receptor in the central nervous system. This results in increased inhibitory neurotransmission, leading to sedation, hypnosis, and anesthesia. Lipuro Emulsion for infusion 200 mg/20 ml induces rapid sleep-like states and can be rapidly reversed upon discontinuation.

How Long Does It Take to Work?

Lipuro Emulsion for infusion 200 mg/20 ml acts very quickly, typically within 30 to 60 seconds after intravenous administration. The onset of anesthesia or sedation is almost immediate, which allows for quick adjustments during procedures.

Absorption

Lipuro Emulsion for infusion 200 mg/20 ml is administered intravenously and is rapidly distributed throughout the body. It does not undergo significant gastrointestinal absorption since it is not given orally.

Route of Elimination

Lipuro Emulsion for infusion 200 mg/20 ml is primarily metabolized in the liver by conjugation and is then excreted in the urine. A small amount is excreted as unchanged drug. The drug's clearance is rapid due to its extensive distribution into tissues and rapid metabolism.

Dosage

Adults:

Induction of general anaesthesia: The dosage of Propofol should be titrated individually against the response of the patient. The ordinary initial dosage in adults is 40 mg (4 ml) by slow intravenous bolus injection at intervals of 10 seconds until the clinical signs show the onset of anaesthesia. The ordinary induction dose in healthy patient below 55 years of age is 2.2-2.5 mg/kg. A dose of 1.0-1.5 mg/kg is often sufficient for older patient. Lower doses, most often 20 mg (2 ml) at intervals of 10 seconds, are recommended for patient of ASA grades 3 and 4.

Maintenance of general anaesthesia: Anaesthesia can be maintained by administering Propofol either by continuous infusion or by repeat bolus injections to maintain sufficient anaesthesia.

Continuous infusion: The required rate of infusion varies considerably between patients. At the onset of anaesthesia (during roughly the first 10-20 minutes), some patient may require a slightly higher infusion rate (8-10 mg/kg/h). However, sufficient anaesthesia is normally achieved by infusing 4-6 (up to 12) mg/kg/h of Propofol. Repeat bolus injections: 25-50 mg (2.5-5.0 ml) bolus injections, depending on response.

Sedation during intensive care: A bolus injection of 1.0-2.0 mg/kg should be given first, followed by continuous infusion adjusted according to required degree of sedation. An infusion rate of 0.3-4 mg/kg/h is usually sufficient.

Sedation for surgical and diagnostic procedures: Dosages shall be adjusted individually. Sufficient sedation for surgical and diagnostic procedures can usually be achieved by administering initially 0.5-1 mg/kg during 1-5 minutes, and maintained by continuous at a rate of 1-4.5 mg/kg/h. Bolus dose of 10-20 mg can be given in addition, should deeper sedation be suddenly required. Lower doses of Propofol are often sufficient for patient of ASA grades 3 and 4, and for older patient.

Children:

Propofol is not recommended for use in children less then 3 years of age as its safety has not been demonstrated.

Induction of general anaesthesia: Dosage of Propofol in children shell be adjusted for weight and age. The mean induction dosage in children over 8 years is 2.5 mg/kg, given by slow intravenous injection until the clinical signs show the onset of anaesthesia. Younger children may need slightly higher doses of propofol per kilogram of weight. Lower dosages are recommended for children of ASA grades 3 and 4.

Maintenance of general anaesthesia: Anaesthesia can be maintained by administering Propofol either by continuous infusion or by repeat bolus injections. Dosage shall be adjusted individually, but an infusion rate of 9-15 mg/kg/h is usually sufficient to achieve satisfactory anaesthesia.

Sedation during intensive care, surgical diagnostic procedures: Propofol is not recommended for sedation in children as its efficacy and safety have not been demonstrated. Although no casual relationship has been established, serious adverse events (including fatalities) have been reported in cases, where propofol has been used against recommendations. Adverse events have most commonly been seen in children with respiratory tract infections given doses in excess of those recommended for adults.

The dosage of propofol varies based on the intended use:

Induction of Anesthesia: Typically 1.5 to 2.5 mg/kg administered intravenously. Dosage may be adjusted based on patient response and clinical conditions.
Maintenance of Anesthesia: Continuous infusion at a rate of 4 to 12 mg/kg/hour. Adjustments are made based on the depth of anesthesia and the procedure's requirements.
Sedation in ICU: Infusion rate of 0.3 to 4 mg/kg/hour, depending on the level of sedation required.

Individual dosing adjustments may be necessary based on patient characteristics and clinical response. Always follow the specific dosage guidelines provided by a healthcare provider.

Administration

Lipuro Emulsion for infusion 200 mg/20 ml is administered intravenously, usually through a central or peripheral vein.
For induction, it is given as a bolus injection, followed by a continuous infusion for maintenance or sedation.
Monitor the patient continuously for vital signs and adjust the dosage as needed.

Side Effects

Common side effects of propofol include:

Hypotension
Respiratory depression
Pain at the injection site
Bradycardia

Serious side effects may include allergic reactions, significant cardiovascular or respiratory complications, and propofol infusion syndrome, particularly with prolonged use or high doses.

Toxicity

Toxicity with propofol can occur, especially with overdose or rapid infusion. Symptoms may include severe hypotension, profound respiratory depression, and cardiac arrhythmias. Immediate medical intervention is necessary in cases of suspected toxicity.

Precautions

Use propofol with caution in patients with cardiovascular, respiratory, or hepatic conditions.
Monitor the patient closely for signs of cardiovascular or respiratory depression, especially during induction and maintenance.
Ensure adequate resuscitation equipment and trained personnel are available during administration.

Interaction

Lipuro Emulsion for infusion 200 mg/20 ml may interact with other central nervous system depressants, such as opioids, benzodiazepines, and inhalational anesthetics, potentially enhancing sedative effects.
Consult a healthcare provider about potential interactions with other medications being administered concurrently.

Disease Interaction

Patients with liver or renal impairment may require dose adjustments due to altered drug metabolism and clearance.
Special caution is required in patients with cardiovascular or respiratory conditions.

Drug Interaction

Lipuro Emulsion for infusion 200 mg/20 ml may interact with medications that affect blood pressure or heart rate, such as antihypertensives or antiarrhythmics.
Concurrent use with other anesthetics or sedatives may necessitate dosage adjustments to prevent excessive sedation or respiratory depression.

Food Interactions

Food interactions are not significant with propofol since it is administered intravenously. However, patients should follow any pre-procedure fasting guidelines as directed by their healthcare provider.

Pregnancy Use

Lipuro Emulsion for infusion 200 mg/20 ml should be used during pregnancy only if the potential benefits outweigh the risks. It is categorized as a pregnancy category B drug, meaning there are no well-controlled studies in pregnant women, but animal studies have not shown risk to the fetus.

Lactation Use

Lipuro Emulsion for infusion 200 mg/20 ml is excreted in breast milk, but the effects on a nursing infant are minimal due to the short-term use and rapid clearance of the drug. Consult a healthcare provider regarding the use of propofol while breastfeeding.

Acute Overdose

Acute overdose of propofol can lead to severe hypotension, respiratory depression, and cardiovascular collapse. Immediate medical intervention is necessary, including supportive care and monitoring. In cases of overdose, manage according to standard emergency protocols.

Contraindication

Lipuro Emulsion for infusion 200 mg/20 ml is contraindicated in individuals with known hypersensitivity to the drug or its components.
It should be used with caution in patients with severe cardiovascular or respiratory disorders.

Use Direction

Administer propofol only in a controlled setting with appropriate monitoring and resuscitation equipment available.
Follow the prescribed dosage and administration guidelines carefully. Adjust dosage based on the patient's response and procedural requirements.

Storage Conditions

Store propofol at room temperature, away from light, and protect from freezing.
Keep out of reach of children and dispose of any unused or expired medication according to local regulations.

Volume of Distribution

Lipuro Emulsion for infusion 200 mg/20 ml has a large volume of distribution, indicating extensive distribution into body tissues. Its high lipid solubility allows it to rapidly cross the blood-brain barrier and other tissue barriers.

Half Life

The half-life of propofol is approximately 2 to 4 hours. However, its effects are shorter due to its rapid redistribution and metabolism.

Clearance

Lipuro Emulsion for infusion 200 mg/20 ml is rapidly cleared from the body through hepatic metabolism. The clearance rate is high due to its extensive distribution and rapid metabolism, allowing for quick recovery from anesthesia or sedation.

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