How Do They Wake You Up From Propofol?
Medically reviewed by Femi Aremu, PharmD
Propofol is a sedative-hypnotic drug used to induce general anesthesia. It can be given intravenously (IV, by injection into the vein). Brand names for propofol include Diprivan.
The Food and Drug Administration (FDA) has approved propofol for inducing or starting anesthesia and maintaining it. It is also approved for keeping you sleepy or sedated with other medications.
The sedative effects of propofol only last for a short time, about three to five minutes following one standard dose, so an individual must administer it throughout the entire surgery.
Understanding your surgical procedures and how you will be put to sleep and woken up is essential. Anesthesia is one aspect of surgery that creates a risk, albeit low risk. The risk of dying from general anesthesia is less than 1 in 100,000.
This article will discuss how propofol and general anesthesia work and how they are reversed after your procedure.
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Understanding General Anesthesia
The purpose of general anesthesia is to take away sensation and consciousness so that you are unaware of the surgery and cannot feel pain during a procedure that would otherwise cause extreme and unbearable pain.
General anesthesia is necessary for most types of major surgery, such as knee and hip replacements, heart surgeries, and many procedures that treat cancer, such as a mastectomy.
General anesthesia is highly effective in keeping you unaware of your surgical procedure.
Millions of surgeries take place across the United States and around the world every day using general anesthesia.
Role of Anesthesiologists
Anesthesiologists wake you up from propofol by stopping the administration of the drug. They control the level in your body by increasing, decreasing, or eventually stopping the infusion, which wakes you up.
This makes the procedure more comfortable and safer because keeping your body completely still can make your surgeon as precise as possible.
This type of healthcare provider will be in charge of keeping you asleep and pain-free throughout your procedure.
Administering Anesthesia
Medications that induce general anesthesia are most often given by injection into your veins, but some types can also be given as a gas that you inhale.
Factors that influence the medications chosen may include your medical status and the preference and experience of your anesthesiologist or nurse anesthetist.
This type of anesthesia is common during major surgical procedures but is only used when necessary.
Alternative Forms of Anesthesia
If possible, you may instead undergo local anesthesia, in which the medication only removes sensation from one part of your body, but you are not unconscious.
One other type of anesthesia apart from general is called MAC (monitored anesthesia care), where you are kept sleepy and given pain medication but still breathe independently.
Specific Types and Classes
Some specific types or classes of general anesthesia include:
IV anesthetics, such as propofol and Amidate (etomidate)
Inhalational anesthetics, such as nitrous oxide or sevoflurane
IV sedatives, such as benzodiazepines
Synthetic opioids, such as morphine and fentanyl
Neuromuscular blocking drugs, such as succinylcholine and rocuronium
What Is Propofol?
Propofol is a generic non-barbiturate sedative.
It is also known by the brand name Diprivan.
However, propofol does not come in combination with any other drug, nor is it found in any other drug product.
The FDA approves propofol for the following uses:
To induce general anesthesia in adults and children 3 years and older
To maintain general anesthesia (a different medication induced that) in adults and children 2 months and older
To induce and maintain MAC in adults or where an anesthesiologist will make sure you remain comfortable and safe but not fully asleep during a procedure
To keep you sleepy but not fully asleep, in combination with other local anesthetic medications
Sedation of adults in the intensive care unit who are intubated and on a mechanical ventilator
The only way to administer propofol is through an IV. It should only be used to induce or start anesthesia in a person who is at least 3 years old.
It may be used to maintain anesthesia in a person as young as 2 months whose anesthesia was started by another medication.
Propofol may occasionally be used for other purposes besides those listed above, such as status epilepticus in children and adults or to treat nausea and vomiting after surgery.
Propofol and COVID-19
One study evaluated people with coronavirus disease (COVID-19) over two years who were mechanically ventilated and had their sedation maintained with propofol.
The study found decreased mortality in those who received propofol for more than 48 hours.
These positive effects may be due to propofol’s antiviral effects and its ability to help control an overactive immune system from producing too much inflammation.
No specific data exists about how commonly propofol is used compared to other anesthetic agents.
Still, it is an increasingly popular choice among anesthesia providers due to the quick emergence from sedation or the tendency for you to wake up after surgery quickly.
It also has less of a “hangover” effect during recovery than other agents.
How Does Propofol Work?
How exactly propofol works to induce anesthesia has yet to be understood entirely.
Anesthetic drugs are thought to work by stopping chemical messengers from moving between neurons in your body, a process called neurotransmission, which causes you to feel pain or other sensations.
Receptors between neurons are responsible for receiving these chemical messages, and a critical type of receptor is the γ-aminobutyric acid type A (GABAA) receptor.
GABAA receptors are found all along your brain and spinal cord and are considered a significant target that general anesthetics block.
Propofol In the Surgical Setting
Before your surgical procedure begins, you will get a line or catheter placed in your arm to provide access to your veins or IV access.
Your anesthesiologist will confirm that propofol is appropriate for you by confirming that you do not have any allergies to anesthetic drugs or a history of a bad experience with any drugs they may use.
Before you are taken into the operating room for surgery, this short discussion will occur with your anesthesiologist.
Once they have affirmed that it is safe, your anesthesiologist will use your IV line to administer propofol as a liquid into your blood. The medication works quickly and typically puts you to sleep in under a minute.
Throughout the procedure, the anesthesiologist will monitor your vital signs, including your heart rate and rhythm, blood pressure, temperature, and body fluid balance, to ensure safety and comfort.
The anesthesiologist will only stop the propofol infusion once your procedure is almost done or complete due to the expeditious manner in which your body clears propofol.
They are very skilled at knowing when exactly to discontinue this medication relative to the progress of your surgery.
How Do They Wake You Up From Propofol?
The act of stopping propofol from infusing into your veins will wake you up from propofol.
This is because the medication is cleared very quickly from your body, so if it stops infusing, you will wake up within minutes.
Right after you wake up, or in the post-operation period, signs that you safely tolerated propofol include typical vital signs, including pulse, blood pressure, and oxygen level, and no or few minor side effects.
Preparing For General Anesthesia
Requirements for using propofol include appropriate age and lack of an allergy to the drug formulation.
Be sure your surgeon has a complete list of medications you take, as some may need to be paused for a certain amount of time before you undergo surgery.
Some conditions may prevent the possibility of treatment with propofol. For example, the drug formulation contains egg lecithin and soybean oil. Therefore, it cannot be used in people with allergies to these components.
Your surgeon or surgeon’s office should have your complete medical history, including allergies, conditions, alcohol or substance use, smoking status, and medications you take.
They will use this information to give you complete directions on everything you need to do before and after going under general anesthesia.
Side Effects and Precautions
Some people experience no side effects from general anesthesia, while others may experience a few.
These side effects are generally short-lasting, typically right after the anesthesia in the minutes to hours after surgery.
Potential side effects of propofol include:
Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
Fast, slow, irregular, or pounding heartbeat or pulse
Problems with movement or coordination
Alternative Treatment Options
If you can’t take propofol, your surgical team can adjust and use alternative options.
There are a variety of types of anesthesia. Propofol is not the only drug available for inducing general anesthesia.
Other intravenous drugs used to induce anesthesia include etomidate, ketamine, and short-acting barbiturates such as thiopental and methohexital.
These medications come with their pros and cons, just like propofol, and still allow a professional to administer safe anesthesia to people unable to use propofol.
Summary
Propofol works by blocking receptors on your nerve endings that are responsible for making you feel stimulation and pain.
If you have allergies to egg or soy, you will not be able to receive propofol, but your surgery team will be able to adjust and use other anesthetic drugs.
Your anesthesia provider will administer propofol medication by injecting it into your vein before your surgical procedure begins.
Propofol will put you to sleep in a matter of seconds because it is a very rapid-acting drug. For this reason, its effects can be stopped by stopping the infusion, which will wake you up from propofol in minutes.
Propofol is a prevalent and effective drug for inducing and maintaining anesthesia. It will be administered by expert providers dedicated to monitoring your health and vital signs throughout your surgery.
You may receive reversal agents for medications besides propofol that are also used to make you sleepy during surgery.
Frequently Asked Questions
Is propofol similar to pentothal? What is pentothal?
Pentothal is similar to propofol in that it is also a sedative and is used to induce anesthesia. Still, it belongs to a drug class called barbiturates, while propofol is a non-barbiturate anesthetic.
Pentothal causes relatively more respiratory depression compared to propofol.
People who received pentothal also had longer recovery times compared to those who received propofol for anesthesia.
How quickly will propofol begin working?
Propofol begins working very quickly. When given at a dose intended to induce anesthesia, you will fall asleep within 40 seconds to 1 minute.
Propofol is lipid-soluble, which means it can easily pass through your blood-brain barrier (BBB) and into your central nervous system (CNS) with very little resistance. This is why it begins to work so quickly.
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