[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Intravenous anaesthetics](https://durgical.com/en/pharmacology/classes/intravenous-anaesthetics/) › Propofol

[Pharmacology](https://durgical.com/en/pharmacology/) · [Intravenous anaesthetics](https://durgical.com/en/pharmacology/classes/intravenous-anaesthetics/)

# Propofol

Intravenous anaesthetic with fast onset and fast wake-up, the most used to induce anaesthesia and sedate. It lowers blood pressure and depresses breathing.

Updated 2026-11-01

- Class: [Intravenous anaesthetics](https://durgical.com/en/pharmacology/classes/intravenous-anaesthetics/)
- Receptor: GABA-A receptor (α1β2γ2)
- ATC code: N01AX10
- WHO Model List of Essential Medicines

## ⚠ High-alert medication

An error with this medicine can cause serious harm: double checks and protocols are used.

Also called: 2,6-diisopropylphenol

◎**GABA-A receptor (α1β2γ2)**Propofol

ⓘ The figure shows propofol bound to the human α1β2γ2 GABA-A receptor, with GABA present, at sites in the transmembrane domain between subunits.

**Target in 3D:** GABA-A receptor (α1β2γ2). PDB structure 6X3T (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/6X3T) · Drag to rotate · pinch to zoom

## Mechanism of action

Propofol is a highly lipid-soluble phenol supplied as a lipid emulsion. It binds the GABA-A receptor and lengthens the GABA-activated opening of the chloride channel. Neurons hyperpolarise and the patient loses consciousness within seconds. The effect of a bolus ends quickly by redistribution, and its rapid hepatic metabolism allows a clear-headed wake-up even after infusions.

- Reaches the brain in one circulation time
- Binds the GABA-A receptor and prolongs chloride channel opening
- Neurons hyperpolarise: hypnosis within seconds
- Redistribution and liver metabolism: rapid wake-up

## Pharmacokinetics

**Distribution**
Rapid equilibration between plasma and brain, then redistribution to muscle and fat. With infusions over days it accumulates in tissues and waking is delayed.

**Metabolism**
Hepatic conjugation (glucuronide and others) to inactive metabolites.

**Elimination**
Kidney, as metabolites; urine may look green, a harmless effect.

**Onset and duration**
Unconsciousness in under a minute after a bolus; waking within minutes of stopping it.

## Indications

- Induction and maintenance of general anaesthesia
- Procedural sedation and monitored anaesthesia care
- Sedation of intubated, ventilated ICU patients

## Adverse effects

### Common

- Pain in the vein on injection
- Hypotension
- Apnoea at induction
- Bradycardia
- Involuntary movements
- Green urine (harmless)

### Serious (rare, important)

- Propofol infusion syndrome: metabolic acidosis, hyperkalaemia, lipaemia, rhabdomyolysis, renal and heart failure, sometimes fatal
- Cardiac arrest and asystole
- Anaphylaxis
- Hypertriglyceridaemia and pancreatitis
- Sepsis from a contaminated vial or syringe

## Contraindications

- Hypersensitivity to propofol or to a component of the emulsion (the label includes egg or soy allergy)

## Key interactions

**Opioids, benzodiazepines and other central nervous system depressants**
Deeper sedation, apnoea and hypotension; lower doses are needed.

**Fentanyl in children**
Higher risk of bradycardia.

**Prior intravenous lidocaine**
Reduces injection pain.

## What is monitored

- Continuous blood pressure, heart rate and rhythm
- Pulse oximetry and capnography; airway
- Depth of sedation
- With prolonged infusion: triglycerides, pH, lactate, potassium, CK and renal function

## Administration and safety

- Strict aseptic technique: the lipid emulsion supports bacterial growth; each vial is for one patient only and is discarded on time together with the line.
- Shake before use and do not give if the emulsion looks separated.
- Use large forearm or antecubital veins to reduce pain.
- Given only by staff trained in airway management who are not performing the procedure.

## Nursing care

- Before: airway equipment, oxygen and suction ready; record baseline blood pressure and saturation.
- During: watch breathing, saturation, capnography and blood pressure continuously.
- In the ICU: assess the level of sedation and neurological function daily to use the lowest effective dose.
- Count the emulsion's lipids within the nutritional intake and check triglycerides during long infusions.
- Report at once unexplained acidosis, dark urine from rhabdomyolysis or ECG changes.

## Pregnancy and breastfeeding

No risk of birth defects has been identified; it crosses the placenta and can depress the newborn if used close to delivery.

## Memory aid

Propofol, the «milk of amnesia»: white, quick in and quick out, but it drops the pressure, stops the breathing and, in a long infusion, can «go sour» (infusion syndrome).

## Test yourself

Think of the answer, then tap the question to see it.

## Which findings define propofol infusion syndrome?

Severe metabolic acidosis, hyperkalaemia, lipaemia, rhabdomyolysis, hepatomegaly, renal and heart failure, and Brugada-like ECG changes.

## Why must an opened propofol vial be used promptly and for one patient only?

The lipid emulsion lets microorganisms grow; late or shared use has been linked to sepsis.

## What is the most important cardiovascular effect of propofol at induction?

Arterial hypotension, from vasodilation and lower contractility, without marked compensatory tachycardia.

## Why does a patient wake quickly after a bolus of propofol?

The drug redistributes from the brain to other tissues and is also metabolised rapidly by the liver.

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## Related drugs

- [Etomidate](https://durgical.com/en/pharmacology/etomidate/)
- [Ketamine](https://durgical.com/en/pharmacology/ketamine/)
- [Dexmedetomidine](https://durgical.com/en/pharmacology/dexmedetomidine/)
- [Thiopental](https://durgical.com/en/pharmacology/thiopental/)

[← Back to the class: Intravenous anaesthetics](https://durgical.com/en/pharmacology/classes/intravenous-anaesthetics/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - PROPOFOL injection, emulsion](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3acf8e6c-827d-11e2-9e96-0800200c9a66) (DailyMed (U.S. National Library of Medicine), 2026); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 24 (McGraw Hill, 2023); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N01AX10) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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