Historical note and terminology
Propofol, a short-acting, non-barbiturate hypnotic for intravenous use, was developed in the United Kingdom in 1970s but was withdrawn from the market due to solubility issues and anaphylactic reactions. An improved emulsion formulation of propofol was introduced under the brand name Diprivan (diisopropyl intravenous anesthetic) in 1986. A water-soluble prodrug formulation, fospropofol, is rapidly broken down in the body to form propofol and was approved by the United States Food and Drug Administration in 2008. Long-term use has been reported to result in addiction, and recreational misuse has been reported. Attention to the risks of non-medical use of propofol came to public attention in 2009 when the Los Angeles County coroner concluded that pop singer Michael Jackson died from a combination of propofol and lorazepam administered at home. However, propofol has not yet been scheduled by the United States Drug Enforcement Administration.
As an anesthetic, propofol is approved for use by anesthetists, but it is being used by nonanesthetists as a hypnotic-sedative during endoscopic procedures. A study has reviewed trends of propofol use by nonanesthetists in different countries (Heuss et al 2012). Swiss gastroenterologists use it without the assistance of an anesthesiologist in the setting of private practice.
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