Propofol


Propofol (2-6 diisopropylphenol) is an alkyl phenol in a lipid vehicle (soybean oil, egg lecithin, glycerol) used in anesthesia.
 
Incidence
1/60 000
 
1.2% of peroperative anaphylactic shocks in France.
 
Risk factors
Previous drug allergy.
 
Allergy to muscle relaxants.
 
Association with atracurium.
 
Clinical manifestations
General: anaphylactic shock.
 
Cutaneous: urticaria, angioedema, facial edema, erythema.
 
Respiratory: bronchospasm.
 
Ocular: conjunctival chemosis.
 
Diagnostic methods
Cutaneous testing

Skin prick-tests.
 
Intradermal skin-tests from 1 µg/ml to 100 µg/ml (1/1000 to 1/10). Positive in most patients with anaphylactic reactions.

Specific IgE (RIA): positive in 10/14 propofol allergic patients.
Leukocyte-specific histamine release: positive in 3/5 propofol allergic patients.
 
Mechanisms
IgE-mediated hypersensitivity in most cases.

Propofol contains 2 isopropyl group that may act as the epitopes.
 
Management
Do not use propofol in muscle relaxant-allergic patients.

Do not use atracurium with propofol (high frequency of anaphylactoid reactions).

Avoidance.

References

  1. Laxenaire M.C, "Utilisation du Diprivan* chez le patient allergique", Ann.Fr.Anesth.Reanim., 1994 ; 13 (4): 498-502
  2. Mc Hale S.P, Konieczko K, "Anaphylactoid reaction to propofol", Anaesthesia., 1992 ; 47 (10): 864-5
  3. de Leon-Casasola O.A, Weiss A, Lema M.J, "Anaphylaxis due to propofol", Anesthesiology, 1992 ; 77 (2): 384-6
  4. Laxenaire M.C, Mata-Bermejo E, Moneret-Vautrin D.A, Gueant J.L, "Life-threatening anaphylactoid reactions to propofol (Diprivan*)", Anesthesiology, 1992 ; 77 (2): 275-80
  5. Mc Leskey C.H, "Anaphylactoid reactions following propofol-atracurium sequence (letter ; comment)", Can.J.Anaesth., 1990 ; 37 (8): 946-7

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.