Drug Choice/Topic/Subject for both Research Paper and PowerPoint Presentation: PROPOFOL

Drug Choice/Topic/Subject for both Research Paper and PowerPoint Presentation: PROPOFOL: This is a two-part assignment. Each part must be completed independently but support the other…

Drug Choice/Topic/Subject for both Research Paper and PowerPoint Presentation: PROPOFOL

PROPOFOL

Drug Choice/Topic/Subject for both Research Paper and PowerPoint Presentation is:

PROPOFOL

·       This is a two-part assignment. Each part must be completed independently but support the other.

·       References can be the same for both the Research Paper and corresponding PowerPoint presentation.

Part 1 – Research Paper

1. Must be a Microsoft Word Document

2. 5 – 6 pages not including Title and Reference pages

3. Minimum 3 references within 5 years

4. APA 7 Format

5. Report Sections

·       Drug class

·       MOA

·       Indications

·       Side effects

·       Administration Routes 

i)      Medication route is either IVP or IV Drip (adult critical care use only) If both apply, mention both

ii)    Recommended titration guidelines

·       Nursing considerations

·       Patient Education

·       At least 2 interventions for administration monitoring and effectiveness of medication

Part 2 – PowerPoint Presentation

PowerPoint must be 16 slides Max – No Minimum but must address the following sections and should only summarize the key concepts or detailed information found in the Research paper. It should not be an exact copy of the Research paper!

·       Drug class

·       MOA

·       Indications

·       Side effects

·       Administration Routes 

i)      Medication route is either IVP or IV Drip (adult critical care use only) If both apply, mention both

ii)    Recommended titration guidelines

·       Nursing considerations

·       Patient Education

·       At least 2 interventions for administration monitoring and effectiveness of medication

·       Reference Page – Can be the same as the research paper (Minimum 3 references within 5 years, APA 7 Format)

Part 1: Propofol
Introduction
The field of anesthesiology has made significant strides in discovering novel methods aimed at delivering care that is not only safe but also effective and efficient. All anesthesiologists endeavor to use a variety of medications in their practice to keep their patients safe, relaxed, and pain-free during surgeries. The medications range from mild sedatives utilized during minor surgical procedures to potent inhalational gases and muscle relaxants for major and lengthy operations. The surgical team should have an adequate understanding of basic general anesthesia principles if the primary goal of anesthesia of rendering the patient unconscious and unable to feel pain while simultaneously controlling autonomic reflexes is to be realized.

According to Smith et al. (2020), the five main classes of anesthetic agents are intravenous (IV) anesthetics like propofol, ketamine, and etomidate, inhalation anesthetics like Sevoflurane, desflurane, and isoflurane, IV sedatives like midazolam, synthetic opioids like alfentanil, sufentanil and fentanyl, and neuromuscular blocking drugs like Succinylcholine and Vecuronium. Suffice it to say that each drug class has its specific strengths and weaknesses in achieving the primary goal of general anesthesia. Therefore, knowledge of these characteristics and significant side effects is paramount for any healthcare professional specializing in anesthesiology.
Feng et al. (2017) observed that propofol with a chemical formula of C12H18O and a chemical name of 2, 6-diisopropyl phenol is the most commonly used IV agent in inducing anesthesia in a patient. It is used to maintain the state of anesthesia and sedation in intensive care units and outpatient procedural settings. Propofol’s popularity stems from its sudden onset, short duration of action, and reduced side effects. Be that as it may, its downsides include emulsion instability, propofol infusion syndrome, microbial contamination, hyperlipidemia, and pain on injection. Consequently, the paper examines the propofol mechanism of action (MOA), its indications, side effects, and routes of administration. The paper further highlights this drug’s recommended titration guidelines, nursing considerations, and patient education to impart to the patient.

Propofol’s MOA

. Ever since John Glen and Roger James patented the drug in 1977, its commercial launch in Europe in 1986, and its debut in the US market in 1989, critical advances in compartmental PK/PD modeling and drug interaction modeling of propofol have been conducted (Sahinovic et al., 2018). In the US, approved propofol formulations are Diprivan injectable emulsion 1% and propofol injectable emulsion 1%. Like many anesthetics, propofol is a gamma-aminobutyric acid (GABA) receptor agonist with favorable profiles in terms of its pharmacokinetics (herein defined as the movement of a drug through the body) and pharmacodynamics (described as the body’s biological response to a drug). In humans, the action of propofol is known to positively modulate the inhibitory function of neurotransmitter GABBA through GABA A receptors. It acts as a potentiator when it targets the GABA receptor subunit in both beta-2 and beta-3 and acts as a positive allosteric modulator in the GABA A receptor. Propofol also has inhibitory effects on sodium channel protein type 4 and type 2 subunit alpha. As the name suggests, 2, 6-diisopropyl phenol, the two isopropyl groups are positioned on either side of a hydroxyl group in the ortho position on a phenol ring, making this molecule highly lipophilic and miscibility that can only be achieved in organic solvents or lipophilic substances.
The Propofol PK follows a three-compartmental linear model that includes the plasma, rapidly and slowly balancing tissues. At first, there is a rapid balancing of propofol levels between the brain and highly perfused brain tissue that explains the rapid onset of anesthesia. Subsequent redistribution from the brain into other balancing tissues brings an end to the anesthetic impact of propofol on the patient.
The PD of Propofol manifests in the central nervous system, where it exerts its hypnotic effect through potentiation of the effects of the inhibitory neurotransmitter GABA. The drug binds to the beta-sub-unit of the postsynaptic GABAA receptor, where it triggers an inward-directed chloride current that hyperpolarizes the postsynaptic membrane while inhibiting neuronal depolarization. Propofol’s other effects on the CNS include amnesia, anxiolytics, analgesic, antiemetic, and neurophysical effects (Sahinovic et al., 2018). Moreover, the PD of Propofol makes it act as a potent ventilator depressant in the respiratory system, reduction of systemic blood pressure and decreasing cardiac output. While liver and kidney functions are not directly affected by propofol, poor maintenance of cardiac output could lead to organ perfusion resulting in compromised liver and kidney perfusion.
Indications
Propofol is a popular intravenous anesthetic utilized during procedural sedation, monitored anesthetic care, and general anesthesia. Its uses in clinical settings include inducing general anesthesia in patients equal to or older than three years. It can also be used to maintain anesthesia in patients more than two months old or for sedation purposes during monitored anesthesia for patients undergoing surgical procedures. Patients in the ICU who are intubated and mechanically ventilated but need sedation can also get propofol. This drug has off-label uses like refractory postoperative nausea and vomiting treatment and management of Status Epilepticus, which is refractory in minors and adults.
 
Propofol is administered to induce and maintain the hypnotic element of sedation or general anesthesia. It is prescribed for patients undergoing surgical procedures that need deep relaxation for extended periods, provided there the patient in context has no contraindications. Anesthesiologists aver that surgical operations where the patient cannot be adequately anesthetized using local or regional anesthesia are the ones that require general anesthesia. According to Smith et al. (2020), surgical processes that could lead to significant blood loss or instances where breathing would be affected require general anesthesia, as do uncooperative patients, even when the latter are in for more minor procedures. In addition, one may have to prescribe propofol on the basis patient’s preference if the patient prefers it when undergoing anesthesia.
On the hand, propofol is contraindicated in patients with hypersensitivity to propofol or any component of its formulation and those with fat metabolism disorders. For example, Hardman et al. (2017) report that case reports abound that advise against Diprivan use in individuals with known allergies to eggs or soybeans and their respective products. Other contraindications are patients with a difficult airway or those with medical conditions not needing optimization before elective surgery.
At all times, propofol administration should be carried out by trained healthcare professionals to ensure patient safety. The anesthetist should closely monitor and promptly act on any changes in the patient’s physiological parameters as set out in the American Society of Anesthesiologists (ASA) guidelines on minimum monitoring standards.
Side Effects
Like any other medication, propofol has several side effects and is administered on the basis that the benefits of its administration outweigh the expected adverse effects. The main side effects of propofol administration are linked to the changes it triggers in the patient’s cardiopulmonary physiology, like loss of airway reflexes, hypoventilation, apnoea, and hypotension. Sahinovic et al. (2018) point out that dose-dependent systemic blood pressure decreases triggered by propofol administration. This side effect is more pronounced in elderly patients and those who are physiologically weakened. The impact is partially mediated by a reduction of sympathetic tone followed by a decrease in vascular resistance. Propofol is also known to inhibit the physiological baroreflex responses, thus promoting cardiovascular depression.
Although very rare, propofol infusion syndrome (PRIS) occurs and clinically manifests as severe metabolic acidosis, rhabdomyolysis, hyperkalemia, and cardiovascular collapse leading to the patient’s death. PRIS happens in extended and high-dose propofol infusion settings, particularly in children. The Diprivan package insert advises against administering propofol at doses higher than 5 mg/kg/h for more than 48 hours.
Administration Routes
Propofol is a popular intravenous anesthetic administered either as a bolus, infusion, or combination (Folino et al., 2020). These researchers note that the medication is prepared in a lipid emulsion, commonly called the milk of amnesia with a formula containing soybean oil, glycerol, egg lecithin, and small doses of preservative EDTA. Maintenance of deep sedation necessitates propofol to be administered using an intermittent bolus technique (Ahmed et al., 2017). Whether using IB or continuous infusion technique, a bolus dose is needed to fill the required amount of the drug. In the continuous infusion technique, the infusion pump lets the sedating practitioner titrate and maintain a constant therapeutic plasma drug level that lowers the fluctuations of drug concentration within the blood. The minimized fluctuations are what lead to smooth and deep sedation. While comparing induction of deep sedation by propofol bolus of 1mk/kg over 1 to 2 minutes versus ketamine bolus (0.5mg/kg for patients less than 20 kg or 0.25 mg/kg for patients weight for those with less than 20 kg), it was found that the propofol IB group achieved a maintenance dose at 10 to 20 mg of propofol.
Recommended Titration Guidelines
The ASA (2015) guidelines recommend that propofol administration be titrated according to the desired clinical effect. For example, in healthy adults less than 55 years, the Diprivan induction dose is set at 2-2.5 mg/kg, administered in boluses of 40 mg every 10 seconds, and titrated to the onset of hypnotic impact, followed by a maintenance dose of 6-12 mg kg/h (Sahinovic et al., 2018). However, to get the exact dosing guidelines, the anesthetist is advised to refer to the package insert since the required dose should be adjusted when the propofol has to be administered to fewer fit individuals undergoing general anesthesia, particularly in patients admitted to the ICU that require induction and maintenance of sedation.
Nursing Considerations
Contemporary healthcare has focused on cost and efficiency, making procedural sedation and analgesia administered by non-anesthesia professionals offer an alternative to many procedures. Subsequently, nursing professionals specializing in anesthesiology must prioritize nursing considerations within the sedation continuum as patients’ needs fall within a state of minimal sedation to general anesthesia (Kost, n.d). Regardless of the goals of general anesthesia, the nursing staff should target to administer the lowest dose that maintains patient safety and welfare, minimizes physical pain and discomfort, controls anxiety, minimizes psychological trauma, optimizes amnesia, and controls behavior and movement to allow safe performance of the procedure in progress. In nurse–administered propofol administration, the personnel involved must be trained in administering general anesthesia without being involved in the conduct of the following surgical or diagnostic procedure.
 Propofol administration in general anesthesia is not easily reversible and can produce rapid, unpredictable results like respiratory arrest hence the need for advanced airway management skills and proficiency in managing cardiovascular complications. The first nursing consideration is to prepare the patient for the requisite interventional/ surgical procedure by collecting the patient’s clinical history and physical assessment. The collection allows the nurse to assess how suitable the patient is for the proposed anesthesia. The second nursing consideration is how best to prepare the environment by ensuring all anesthetic equipment and medications, including those needed in the event of complications, are present (Lemos et al., 2017). These include a pulse oximeter, ventilators, capnography, and video laryngoscope with matching human personnel who possess the proper knowledge and skills. The next point to consider is that an anesthetized patient will have their physiological functions impaired to lesser or higher degrees hence the need for close monitoring. The monitoring as captured in the devices gives the nurse some insights into the patient’s health status. The fourth nursing consideration is always to be alert since complications can still arise despite the preparation and monitoring. Prompt detection of any adverse event, initiation of appropriate intervention, communicating with other medical team members, and helping in the interventions are necessary, as is delegation of tasks and keeping records as required. The fifth and last nursing consideration addressed herein is that the anesthetic nurse must help the patient regain physiological functions impaired by the propofol administered. The nurse should pay closer attention to airway patency, ventilator, circulatory, and neurological systems as this helps avoid postoperative delirium. The concerned nurse should check their state board of nursing legislation to ensure their administering of propofol is within that state’s scope of practice.

Patient Education
Before administering propofol, the anesthetic nurse must educate the patient on what general anesthesia entails, like the fact that it entails relaxing the muscles in one’s digestive tract and airway that prevent food and acid from passing from the stomach into the lungs. It is also essential to make the patient aware of the need to fast before propofol can be administered and what to expect after the surgical process. Other components of patient education include the medications to take or avoid before the procedure as this helps control the patient’s anxiety.
Conclusion
In conclusion, this essay has established that propofol is a commonly used agent to induce anesthesia. Nurse anesthetists, anesthesiologists, and intensivists use this agent and must have adequate knowledge of its benefits and adverse effects. Its benefits rest on tits rapid and smooth induction of anesthesia accompanied by almost no excitation phenomena, comparatively short- context-sensitive time, low incidence of postoperative nausea and vomiting, and a rapid terminal half-life time. The drawbacks of its use include emulsion instability, hyperlipidemia, PRIS, microbial contamination, and pain upon injection. Propofol’s clinical uses include induction of general anesthesia, maintenance of anesthesia inpatients, sedation during times of monitored anesthesia, and sedation in patients admitted to the ICU. Its MOA is poorly understood but is believed to be connected to the effects of GABA- mediated chloride channels within the brain. This agent may work by decreasing the dissociation of GABA from GABA receptors and potentiating the inhibitory impact of the neurotransmitter. There is a need for collaboration amongst all procedural team members beginning with the physicians to specialists, nurses, and surgical assistants leading to optimal patient outcomes where propofol is used for general anesthesia.

Part 2 to be availed on request.