Fospropofol is a watersoluble prodrug of propofol that results in incomplete (20–30%) liberation of propofol into the systemic circulation by alkaline phosphatase. It is believed that most (70–80%) of the propofol liberated is further metabo-lized prior to entering the systemic circulation. The peak hypnotic effect occurs approximately 10 minutes following a bolus injection. The kinetic disposition of liberated propofol differs from that of an injected propofol emul-sion, with the former being slower for reasons that remain unexplained.
Apparent advantages of an aqueous solution of fospropofol are a reduced risk of bacterial contamination com-pared with a propofol emulsion and the absence of an infused lipid load that has been associated with organ toxicity during long-term infusions of a propofol emulsion. Whether the new medication will cause less pain on injection remains to be determined. The relatively slow-onset kinetics of fospropofol probably would not make it useful for induction of general anesthesia. It may find utility for sedation in the ICU, procedural sedation outside of the operating room (where its safety needs to be demonstrated), and for sedation during monitored anesthesia care or regional anesthesia during which a rapid onset is less critical.
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