Life-threatening reactions to propofol

To the Editor: Propofol (2,6-diisopropyl phenol; Diprivan; Stuart Pharmaceuticals, Wilmington, DE) has been advocated as a titratable continuous infusion anesthetic agent associated with fast and smooth recovery (2, 7). The anesthetic properties of a smooth induction, short half-life, and rapid emergence from anesthesia after prolonged operations, with a low incidence of nausea and vomiting and little "hangover' sedation, suggest that this agent may be ideally suited for use in intracranial neurosurgery (6). It also may be given in combination with analgesics, such as sufentanyl and inhalational agents. Accordingly, we have adopted propofol for use in all cranial base, vascular, and functional neurosurgical procedures. We are currently using propofol (50-100 /ig/kg/min infusion, with a burst suppression dosage of approximately 250 jiig/kg/min used during periods of vascular interruption) in a balanced protocol with narcotic (sufentanyl) and low dosage inhalational (isoflurane) anesthesia.