Propofol for cats: instructions for use, composition, dosage and price

Pharmacological action of the drug

Propofol is a general anesthetic classified as a hypnotic. This product will quickly put your pet to sleep. Features of the drug: The stage of excitation during exposure to the drug is not observed in most cases. In small doses it provokes sedation - it puts the pet into a shallow sleep, relieving nervous tension. Propofol does not act as an analgesic. It dulls sensitivity, thereby increasing the pain threshold. The product has virtually no negative effects on the cardiovascular system. Until now, scientists cannot accurately describe the mechanism of action of propofol on the body of cats. But it is known that the drug reduces the activity of GABA mediators, causing inhibitory reactions in the central nervous system. An important advantage of propofol is that it accumulates slowly in the body. As a result, there is no tolerance, and the patient quickly recovers even after prolonged infusion therapy. When the drug enters the body, it combines with blood plasma proteins. Most of the metabolites are generated by the kidneys, and the metabolism itself occurs both in the liver and beyond. The duration of the effect varies from 5 to 10 minutes. Such a short duration of action is explained by the high purification coefficient of propofol: anesthesia, entering the brain and other organs in which there are many blood vessels, quickly passes into tissues with less strong blood supply, and at the same time the effect weakens.

Pharmacology and mechanism of action

Hypnotic. The mechanism of action is not well defined, but it is likely that it produces effects through a mechanism similar to barbiturates. Consequently, it causes central nervous system (CNS) depression through its effects on GABA receptors. Propofol reduces the effects of GABA from dissociation to binding of its receptors

, thereby increasing chloride channel conduction, hyperpolarization of postsynaptic cell membranes, and inhibition of postsynaptic neurons. This produces the narcotic and hypnotic effect observed in animals. Propofol induces short-term anesthesia (10 minutes) followed by a rapid and smooth recovery. The original formulation contains propofol in castor oil. There are other formulations containing soybean oil, glycerin and purified egg phospholipids. The newest formulation contains 1% propofol in an emulsion mixture of medium and long chain triglycerides, which provides good encapsulation and a lower concentration of free propofol.

Instructions for use

The only way to use propofol is intravenous injection (allowed undiluted). The product must be administered by a qualified veterinarian in an equipped veterinary clinic. The dosage is selected individually in each case. It depends on the condition of the pet’s heart and blood vessels, as well as on the goals being pursued. For example, if you need to diagnose and reduce discomfort for the cat, the dosage will be less than in the case of a more serious surgical intervention that requires complete loss of sensitivity. General instructions: Make sure the ampoule is tightly closed. Shake it and open it. Disinfect the neck of the ampoule with alcohol. Draw into a syringe and give an intravenous injection.

Note: to increase the duration of the effect, propofol is often used in combination with other analgesic drugs.

What does the drug contain? Propofol contains: Soybean oil. Lipids from egg yolk. Oleic acid. Sodium hydroxide. Medium chain triglycerides. Water for injections. Visually, the drug is a homogeneous white emulsion with a faint smell of phenol (gouache). Recommended dosages of propofol for cats Propofol is used in veterinary medicine for many purposes. Depending on what exactly the injection is for, the dosage of propofol differs: From 4 to 8 mg/kg - preliminary preparation for surgery to reduce anxiety and enhance the effect of the drug during subsequent anesthesia. 2 – 6 mg/kg – this is the dose of hypnotic prescribed if premedication with sedatives was not given. 0.2 – 2 mg/kg/min – maintenance dose through a dropper to induce deep sleep without obstructing the airway. 0.4 – 0.5 mg/kg/min – prescribed for brushing teeth, examining the oral cavity and other painless procedures performed in a monotonous manner. 0.12 – 0.3 – during surgery in combination with sufantenil, fentanyl and other opioid analgesics.

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Propofol-Lipuro, 10 mg/ml, emulsion for intravenous administration, 20 ml, 5 pcs.

IV.

Recofol® 10 mg/ml

Recofol® 10 mg/ml is prescribed only intravenously

. In order to reduce the pain of the injection, the initial dose of Recofol® immediately before administration can be mixed in a plastic syringe with lidocaine (10 mg/ml) at the rate of 1 part lidocaine injection to 20 parts of Recofol®.

All actions with Recofol® 10 mg/ml and the equipment necessary for its administration must be carried out under conditions of strict sterility, since Recofol® does not contain any antimicrobial preservatives and, like any lipid emulsion, promotes the growth of bacteria and other microorganisms. Recofol® is drawn into a sterile syringe under sterile conditions immediately after opening the ampoule or vial, and then administered immediately. Any fluids prescribed together with Recofol® should be administered as close to the catheter as possible. Recofol® is not administered through a microbiological filter.

Recofol® 10 mg/ml can be administered either undiluted or diluted for infusion. Each ampoule or vial should be carefully inspected for abnormalities before injection or dilution. If any changes are detected, the drug should not be used. Shake slightly before use. Remains of any solutions should be destroyed.

Proper equipment must be used to ensure the required infusion rate. Drop counters, metered infusion or syringe pumps are quite suitable for this purpose. The use of a conventional infusion set does not reliably prevent accidental overdose. When determining the maximum volume of propofol in a burette, the risk of uncontrolled infusion must be taken into account. Simultaneously with Recofol® 10 mg/ml, it is allowed to administer sodium chloride or dextrose solution through a Y-shaped connector.

Recofol® 10 mg/ml can be diluted with 0.9% sodium chloride solution or 5% dextrose solution for infusion. It should be diluted no more than 5 times (minimum propofol content 2 mg/ml), and use a PVC bag or glass infusion bottle for this purpose. If a PVC infusion bag is used, the full bag should be taken and the solution prepared by removing part of the infusion fluid and replacing it with an equal volume of propofol. Particular attention should be paid to preparing the solution under sterile conditions immediately before administration. Any diluted solutions must be used within 6 hours of preparation. Remains of any solutions must be destroyed. The dilution method is indicated in the table.

Table

Dilution and simultaneous administration of Recofol® 10 mg/ml with other drugs

Doses

The dose of Recofol® 10 mg/ml is individually selected by an experienced anesthesiologist depending on the patient’s body weight, sensitivity to propofol and other concomitant medications. Recofol® is also used for sedation during surgical and diagnostic procedures and has been used in combination with spinal epidural anesthesia. It is recommended to titrate propofol depending on the patient's response until clinical signs of anesthesia appear.

For adults

Induction of anesthesia

The dose of Recofol 10 mg/ml should be titrated individually (20–40 mg propofol every 10 s) depending on the patient's response. For induction of anesthesia, Recofol® 10 mg/ml can be used as a slow bolus injection or infusion. Most adult patients under 55 years of age will likely need to be given propofol at a dose of 1.5–2.5 mg per kg body weight. Older patients and patients with ASA anesthetic risk grades 3 and 4, especially those with compromised cardiac function, will require lower dosages and the total dose of Recofol® 10 mg/ml may be reduced to the minimum of 1 mg propofol per 1 kg body weight. In such patients, the drug should be administered at a lower rate - approximately 2 ml (or 20 mg) every 10 s. The total dose may be reduced at a lower rate of administration (20–50 mg/min).

Maintaining general anesthesia

Anesthesia is maintained by administering Recofol® 10 mg/ml by continuous infusion or repeated bolus injections to ensure sufficient anesthesia.

Continuous infusion.

The required infusion rate varies markedly between patients. To maintain general anesthesia, propofol should be prescribed at a dose of 4–12 mg/kg/h. In older, debilitated patients, and in patients with hypovolemia or ASA grades 3 and 4, the dose should be reduced to 4 mg/kg/hour. Once anesthesia has established (approximately the first 10–20 minutes), a slightly increased infusion rate (8–10 mg/kg/hour) may be indicated in some patients.

Repeated bolus injections: Bolus injections of 25–50 mg (2.5–5.0 mL) depending on patient response. Elderly patients should not be given rapid bolus injections (single or repeated) as this may lead to cardiopulmonary failure.

Providing sedation for mechanically ventilated patients during intensive care

For sedation during intensive care, it is recommended to administer propofol by continuous infusion. The rate of infusion is determined by the desired depth of sedation. In most patients, adequate levels of sedation can be achieved with a propofol dose of 0.3–4 mg/kg/h. Prescribers are advised not to exceed a dose of 4 mg/kg/h, if possible (see Precautions). The duration of continuous propofol infusions should not exceed 7 days. To provide sedation in intensive care units, it is not recommended to administer propofol using TCI (targeted controlled infusion) systems.

Sedation for surgical and diagnostic procedures

The dose should be selected individually. Sufficient sedation for surgical and diagnostic procedures is usually achieved by initially administering 0.5 to 1 mg/kg/hour over 1 to 5 minutes and then maintaining a continuous infusion at a rate of 1 to 4.5 mg/kg/hour. If there is a need to obtain greater sedation, then an additional bolus dose of propofol of 10–20 mg can be administered. In patients with ASA grades 3 and 4 and in elderly patients, lower doses of propofol are often sufficient.

For children

Introduction to anesthesia

Propofol is not prescribed to children under 1 month of age.

For induction of anesthesia, the dose of Recofol® 10 mg/ml should be slowly titrated depending on the patient's response until clinical signs of anesthesia appear. The dosage should be adjusted depending on age and/or body weight. For most patients over 8 years of age, a dose of approximately 2.5 mg of Recofol 10 mg/ml per kg body weight is likely to be sufficient for induction of anesthesia. The required dose for patients younger than this age may be higher (2.5–4 mg/kg). Due to the lack of clinical data regarding children at high risk (ASA grades 3 and 4), such patients are prescribed lower doses of Recofol® 10 mg/ml.

Maintaining general anesthesia

Propofol is not prescribed to children under 1 month of age.

Anesthesia is maintained by administering Recofol® by continuous infusion or repeated bolus injections. Dosage must be individualized, but an infusion rate of 9–15 mg/kg/h is usually sufficient to achieve the required anesthesia. There are no data available for children with ASA grades 3 and 4.

Patients younger than 3 years of age may require a higher dose of the recommended dose range than older children. The dose should be individualized and particular attention should be paid to ensuring adequate pain relief (see also Precautions).

According to studies of the maintenance of general anesthesia, in children under 3 years of age, the duration of drug use was most often about 20 minutes with a maximum of 75 minutes. Therefore, the maximum duration of approximately 60 minutes should not be exceeded, unless longer use is indicated, such as in malignant hyperthermia, in which case the use of inhalational anesthetics should be avoided.

Sedation for intensive care, surgical and diagnostic procedures

Propofol for sedation in intensive care is not prescribed to patients under the age of 16 years (see “Contraindications”). Serious side effects (including deaths) have been reported when propofol was used outside of recommendations, although a causal relationship between these events and the use of propofol has not been proven. Side effects were most common in children with respiratory tract infections when doses higher than recommended adult doses were given.

Recofol® 20 mg/ml

Recofol® 20 mg/ml is administered undiluted. Each ampoule or vial should be carefully inspected before injection for abnormalities. If any changes are detected, the drug should not be used. Shake slightly before use. Remains of any solutions should be destroyed.

Proper equipment must be used to ensure the required infusion rate. Drop counters, metered infusion or syringe pumps are quite suitable for this purpose. The use of a conventional infusion set does not reliably prevent accidental overdose. When determining the maximum volume of propofol in a burette, the danger of uncontrolled infusion must be taken into account.

The dose of Recofol® 20 mg/ml is individually selected by an experienced anesthesiologist depending on the patient’s body weight, sensitivity to propofol and other concomitant medications. Recofol® is also used for sedation during surgical and diagnostic procedures and has been used in combination with spinal and epidural anesthesia.

For adults

Introduction to anesthesia

The dose of Recofol 20 mg/ml should be titrated individually (20–40 mg propofol every 10 s) depending on the patient's response. Most adult patients under 55 years of age will likely need to be given propofol at a dose of 1.5–2.5 mg per kg body weight. Older patients and patients with ASA grades 3 and 4, especially those with weakened cardiac function, will require lower dosages and the total dose of Recofol® 20 mg/ml may be reduced to a minimum of 1 mg propofol per 1 kg body weight. In such patients, the drug should be administered at a lower rate - approximately 1 ml (corresponding to 20 mg) every 10 s. The total dose may be reduced at a lower rate of administration (20–50 mg/min).

Maintaining general anesthesia

Anesthesia is maintained by administering Recofol® 20 mg/ml by continuous infusion.

The required infusion rate varies markedly between patients. To maintain general anesthesia, propofol should be prescribed at a dose of 4–12 mg/kg/h. In older, debilitated patients, and in patients with hypovolemia or ASA grades 3 and 4, the dose should be reduced to 4 mg/kg/hour. Once anesthesia has established (approximately the first 10–20 minutes), a slightly increased infusion rate (8–10 mg/kg/hour) may be indicated in some patients.

Sedation of mechanically ventilated patients during intensive care

For sedation during intensive care, it is recommended to administer propofol by continuous infusion. The rate of infusion is determined by the desired depth of sedation. In most patients, adequate levels of sedation can be achieved with a propofol dose of 0.3–4 mg/kg/h. Prescribers are advised not to exceed a dose of 4 mg/kg/h, if possible (see Precautions). The duration of continuous propofol infusion should not exceed 7 days. To provide sedation in intensive care units, it is not recommended to administer propofol using TCI (targeted controlled infusion) systems.

Sedation for surgical and diagnostic procedures

The dose should be selected individually. Sufficient sedation for surgical and diagnostic procedures is usually achieved by initially administering 0.5 to 1 mg/kg/hour over 1 to 5 minutes and then maintaining a continuous infusion at a rate of 1 to 4.5 mg/kg/hour. In patients with ASA grades 3 and 4 and in elderly patients, lower doses of propofol are often sufficient.

For children

Introduction to anesthesia

Propofol is not prescribed to children under 1 month of age.

For induction of anesthesia, the dose of Recofol 20 mg/ml should be slowly titrated depending on the patient's response until clinical signs of anesthesia appear. The dosage should be adjusted depending on age and/or body weight. For most patients over 8 years of age, a dose of Recofol 20 mg/ml at approximately 2.5 mg/kg body weight will likely be sufficient for induction of anesthesia. The required dose for patients younger than this age may be higher (2.5–4 mg/kg). Due to the lack of clinical data regarding children at high risk (ASA grades 3 and 4), such patients are prescribed lower doses of Recofol® 20 mg/ml. Recofol® 20 mg/ml is not recommended for use during anesthesia in children from 1 month to 3 years of age, due to the difficulty of accurately administering small volumes of the drug (see also “Precautions”). In such cases, it is recommended to use Recofol® 10 mg/ml.

Maintaining general anesthesia

Propofol is not prescribed to children under 1 month of age.

Anesthesia is maintained by administering Recofol® through a continuous infusion. Dosage must be individualized, but an infusion rate of 9–15 mg/kg/h is usually sufficient to achieve the required anesthesia. There are no data available for children with ASA grades 3 and 4.

Young patients (under 3 years of age) may require a higher dosage range than older children. The dose should be individualized and particular attention should be paid to ensuring adequate pain relief (see also Precautions).

According to studies of the maintenance of general anesthesia in children under 3 years of age, the duration of drug use was most often about 20 minutes with a maximum of 75 minutes. Therefore, the maximum duration of approximately 60 minutes should not be exceeded, unless longer use is indicated, for example in malignant hyperthermia, in which case the use of inhalational anesthetics should be avoided.

Sedation for intensive care, surgical and diagnostic procedures

Propofol for intensive care sedation is not indicated for patients 16 years of age or younger (see Contraindications).

Serious side effects (including deaths) have been reported when propofol was used outside of recommendations, although a causal relationship between these events and the use of propofol has not been proven. Side effects were most common in children with respiratory tract infections when doses higher than recommended adult doses were given.

Adverse reactions from taking the drug

With propofol, side effects are kept to a minimum, but they still exist: When falling asleep, there is a slight decrease in breathing, and in some cases it may even stop for a few seconds. During induction anesthesia – pain at the injection site. Convulsions and thrombosis are possible. Upon awakening - headache, sneezing, nausea and vomiting. Propofol as anesthesia: complications, contraindications and precautions Propofol should not be used if the animal has hypersensitivity to any of the components present in the composition. In addition, the product is not suitable for pregnant cats, as it can cause irreparable harm to kittens. Otherwise, the drug can be used for any short-term intervention: both for superficial sedation and for immersion in deep medicated sleep. According to research results from independent laboratories, propofol is one of the safest anesthetics for cats. Unlike inhaled pain relievers, when taking the drug, blood pressure practically does not change, and awakening occurs quickly, regardless of the amount and duration of administration.

Indications and clinical use

Propofol is used as a short-term injectable anesthetic.

It can be used as an anesthesia induction drug followed by inhalation with halothane or isoflurane. The advantage of propofol over other agents is its smooth and rapid recovery. It can be used with acepromazine, diazepam, alpha2-agonists (eg, dexmedetomidine), butorphanol, and inhalational anesthetics. An additional use of propofol is the treatment of status epilepticus. It has been used safely and effectively for short-term induction and surgical procedures. Propofol is also suitable for procedures that require repeated episodes of anesthesia in dogs and cats without causing side effects.

Dosage of the drug for large animals

Use of propofol in horses

The dose of propofol for horses is 2 mg/kg
IV bolus. Guaifenesin (90 mg/kg IV) should be administered before propofol to prevent agitation, myotonia, and other problems during recovery.

Use of propofol in small ruminants

Propofol is administered intravenously to sheep and goats at a dose of 4 mg/kg.

Use of propofol in pigs

Propofol is used in pigs at a dose of 2-5 mg/kg intravenously.

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Precautionary measures

Adverse reactions and side effects.

Apnea and respiratory depression are the most common side effects and are more likely to occur as the dose is increased. Propofol may cause dose-dependent cardiovascular depression, but the severity of cardiac adverse events is generally low. However, propofol may cause vasodilation, which can be minimized by adding intravenous fluids. Propofol may cause spontaneous muscle movements (swimming movements, tremors, muscle rigidity), dyspnea, nystagmus, salivation and tongue retraction in some animals (incidence 3%-7%). Less common adverse reactions include vomiting on awakening and pain. Pain after injection is common in humans, but less common in dogs. Injection pain is caused by the free propofol in the formulation and decreases with newer formulations. Phenolic drugs such as propofol may potentially cause oxidative damage to hemoglobin in cats due to the higher concentration of oxidizable sulfhydral groups in feline red blood cells (RBCs), leading to the formation of Heinz bodies and methemoglobinemia. However, this was not a consistent problem in routine clinical use, and repeated episodes of anesthesia were safe in cats. Some formulations may contain 2% benzyl alcohol (20 mg/ml), which may cause hematological disturbances in some animals. However, this ingredient did not cause additional morbidity or problems in cats compared to other drugs.

When used alone in horses, propofol can cause agitation, myotonia and problems during recovery.

Therefore, other sedatives are recommended when used in horses.

Contraindications and precautions

Propofol may cause apnea, hypoxia and cyanosis upon induction.

Supplemental oxygen should be available to prevent side effects. Do not use in animals with hypotension. When propofol is used to sedate animals during intradermal skin testing, it may cause a higher number of false-positive reactions. Propofol should not be used alone for pain relief in horses or in combination with other sedatives or premedications.

Interactions of propofol with other drugs. Propofol can be used safely with several other anesthetics. It was combined with sodium thiopental (2.5%) in a 1:1 mixture without loss of effectiveness. Propofol has been used with atropine, glycopyrrolate, acepromazine, xylazine, oxymorphone, halothane and isoflurane, without any interactions.

Stability and storage

Store at temperatures between 4 and 25°C.

Avoid freezing. Keep away from light. Shake well before use. The original composition is used in ampoules and vials without preservatives and must be used within 6 hours. Use careful and aseptic technique to prevent microbial contamination of this formulation.

Newer formulations contain preservatives that provide a 28-day shelf life once the bottle is opened. Propofol can be mixed with sodium thiopental in a 1:1 mixture; these drugs are physically and chemically compatible. However, do not mix with other drugs unless their compatibility is known or studied. Propofol has a pH of 7-8.5. Keep away from light. Store at 4–22°C. Do not freeze.

Patient monitoring and laboratory tests

Monitor respiratory rate and pattern during propofol anesthesia.

Veterinary forms of propofol are available in multi-dose vials containing 10 mg of active ingredient per ml.

Propofol is slightly soluble in water; therefore, it is in pharmaceutical form as a white oil-in-water emulsion. It also contains soybean oil (100 mg/ml), glycerin (22.5 mg/ml), egg lecithin (12 mg/l) and oleic acid (0.6 mg/ml) with sodium hydroxide to adjust pH. Propofol emulsion is isotonic and has a pH of 6.0-9.0.