The primary endpoint of this study is to determine how much omega-6 fatty acid patients are exposed to while on a propofol drip. Additional endpoints evaluated were to determine if using propofol decreases the use of concomitant sedative infusions and whether analgesic infusions were co-administered.
This is a retrospective, cohort study that looked at propofol use in critical care units of a community hospital in January 2008. To be included patients had to receive propofol for longer than six hours and be greater than 18 years of age. We obtained our initial set of patients receiving propofol by filtering ICD-9 codes for propofol charges. From this list, we reviewed the charts to determine if patients received propofol, how much propofol they received, and if they received any other sedative or analgesic infusions.
We identified 35 individual patients that actually received propofol for greater than 6 hours. The minimum amount of propofol infused in a 24 hour period was 39 mL, maximum was 9886 mL, and median was 329 mL. This resulted in omega-6 exposure in a 24 hour period at a minimum of 1.9 gm, maximum of 504 gm, and a median of 16.8 gm. Four patients received another sedative and analgesic infusion, two patients received just another sedative infusion, and four received an analgesic infusion.
On average our patients receive 16.8 gm of omega-6 from propofol in a day. Therefore, they are exposed to nearly two-thirds the amount of omega-6 as a dose of lipids with a TPN exposes them to. While most patients receive propofol for less than 24 hours, extended infusions can expose patients to significant amounts of omega-6. This should raise questions as to the safety of propofol. Few patients received sedative infusions while on propofol in this study.
Current guidelines recommends no soy-based lipids during the first week in the ICU. Additionally, propofol is used frequently without concomitant analgesic therapy, which shows an area for improvement.
Marintha Short, Consultant fee, speaker bureau, advisory committee, etc. Abbott's Speaker Bureau; No Product/Research Disclosure Information