First-lineDiprivan
Propofol
GABA-A positive modulator IV induction agent
Induction agent of choice for elective LSCS under GA.
IV
First-line for
- Induction of general anaesthesia for LSCS
- TIVA maintenance
- Sedation on ICU (short term)
Mechanism
Enhances GABA-A chloride flux → rapid loss of consciousness within one arm-brain circulation.
"Propofol = pain, pressure drop, propofol infusion syndrome"
- Add lidocaine 20 mg to reduce injection pain
- Hypotension — pre-load fluids, vasopressor ready
- PRIS: acidosis, rhabdo, cardiac failure with prolonged high-dose infusion
Dosing
- Induction
- 1.5–2.5 mg/kg IV (reduce in shock, elderly)
- TIVA maintenance
- 4–12 mg/kg/h
Contraindications
- AbsoluteEgg or soybean anaphylaxis
Side effects
- Injection pain
- Hypotension, apnoea
- Bradycardia
- PRIS with prolonged high-dose use
Fetal & maternal notes
- • Crosses placenta but rapidly redistributed — minimal neonatal depression at standard induction doses
Key interactions
Opioids, benzodiazepines
CautionAdditive hypotension and apnoea
Clinical pearls
- 💡 Combine with alfentanil or remifentanil for haemodynamic stability
- 💡 Use rapid sequence induction technique in obstetrics
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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