What Is Pofol

Pofol, anesthetic drug used to induce and maintain general anesthesia and to sedate patients for certain medical procedures. Pofol was first tested clinically in 1977. When administered by intravenous injection, it quickly induced anesthesia, with fast and smooth recovery afterward. Animal studies, however, revealed the potential for severe allergic reactions. With subsequent reformulation of pofol into an oil-based emulsion, giving it a milky appearance, this challenge was overcome, and pofol gained widespread use as a key anesthetic agent.

As a general anesthetic, pofol initially is given at a relatively high dose to produce a loss of consciousness in the patient and then is infused continuously in smaller amounts to maintain an unresponsive state; this approach typically is used in patients who are undergoing major surgery. At lower doses, pofol acts as a conscious sedative (or procedural sedative), inducing a semiconscious state. The sedative effects set in and wear off quickly, making pofol an effective agent for inducing mild sedation in outpatient surgeries.
Side effects of pofol include pain at the injection site, hypotension, hypertension, nausea, cough, tingling sensation, and itching Rare side effects include arrhythmia, convulsion, and cardiac arrest. Pofol interacts with numerous other drugs, including chloral hydrate, diazepam, fentanyl, and morphine; such interactions can increase the anesthetic and sedative effects of pofol, producing potentially dangerous effects, such as cardiorespiratory depression and slowing of heart rate. Cardiac arrest caused by interaction between pofol and multiple benzodiazepines was responsible for the death of American singer and songwriter Michael Jackson in 2009.

What side effects does pofol have?
It can cause a decrease in blood pressure, it can depress or even stop breathing, and it can cause pain on injection. The package insert with the drug states that it should only be used by persons trained in the administration of general anesthesia, which in this hospital means an anesthesiologist. In the ICU, it is restricted only for use in intubated, mechanically ventilated patients.

Why restrict it to use under an anesthesiologist's guidance?
Pofol can be deceptively easy to use. Because people recover so quickly, there's a temptation to use it in places which aren't safe. But it's stronger than other drugs, and can clearly destabilize blood pressure and breathing, Users can easily slip over the line from sedation to general anesthesia, develop blood pressure or breathing difficulties, and need specialized resuscitation measures.

You chose to study the effects of pofol on sleep deprivation. Is sleep deprivation an issue in the ICU?
Sleep deprivation is a huge issue in the ICU, and has been documented since the 1980's. Because of potential pain and anxiety, because the lights are always on, because there is noise always present and nurses are checking on patients on an hourly basis, there is really no quiet time. The circadian rhythms and light cycles that people are normally exposed to aren't as present in an ICU setting either. No one knows whether sleep deprivation adversely affects outcomes in the ICU because there's no way to set up a control for sleep, but many of the effects of sleep deprivation can clearly make care in the ICU more difficult.