PACKAGE LEAFLET: INFORMATION FOR THE USER Propofol 10 mg/ml Emulsion for injection/infusion propofol Read all of this leaflet carefully before you start using this medicine because it contains important information for you. - Keep this leaflet. You may need to read it again. - If you have any further questions, ask your doctor or pharmacist or nurse. - If you get any side effects, talk to your doctor or pharmacist or nurse. This includes any possible side effects not listed in this leaflet. See section 4. What is in this leaflet: 1. What Propofol 10 mg/ml is and what it is used for 2. What you need to know before you use Propofol 10 mg/ml 3. How to use Propofol 10 mg/ml 4. Possible side effects 5. How to store Propofol 10 mg/ml 6. Contents of the pack and other information. 1. What Propofol 10 mg/ml is and what it is used for Propofol 10 mg/ml is a short-acting anaesthetic, which is injected into a vein. Propofol 10 mg/ml belongs to a group of medications that are called general anaesthetics (anaesthetics). General anaesthetics are used to trigger unconsciousness (a type of sleep), so that surgeries and other treatments can be performed. They can also be used for sedation (so that you are sleepy but are not really sleeping). Propofol 10 mg/ml is used for: • Induction and maintenance of anaesthesia in adults and children from 1 month of age, • Sedation (calming) of ventilated patients over 16 years of age during intensive care, • Sedation of adults and children from 1 month of age for surgical and diagnostic procedures, alone or in combination with local or regional anaesthesia (local anaesthetic). 2. What you need to know before you use Propofol 10 mg/ml Do not use Propofol 10 mg/ml: If you are allergic to propofol, soybeans, peanuts or any of the other ingredients of this medicine (listed in section 6), for the sedation of patients aged 16 years or younger as part of intensive care. Warnings and precautions Talk to your doctor before using Propofol 10 mg/ml. Particular care is required when using Propofol 10 mg/ml in the case of lipid metabolism disorders, diseases, as a result of which fat-containing emulsions should be used with caution. (See the notes regarding intensive medical care by a doctor.) Propofol 10 mg/ml should be administered in a slower manner than normal for patients in a poor general state of health, with heart, breathing, kidney and liver disorders, with fluid loss (hypovolemia). Heart, circulatory and respiratory insufficiency as well as hypovolemia should be treated prior to administration of the drug if, possible. A pronounced drop in blood pressure may necessitate the administration of plasma substitutes, possibly of vasoconstrictors, and slower administration of Propofol 10 mg/ml. The possibility of a massive drop in blood pressure should be taken into consideration for patients with reduced coronary or cerebral perfusion or with hypovolemia. The decomposition of Propofol is dependent on the blood flow. Therefore, if drugs are used at the same time that reduce the cardiac output, the Propofol decomposition will also be reduced. Patients with severe heart disease require careful administration of Propofol 10 mg/ml with strict monitoring. When using Propofol 10 mg/ml in people with epilepsy, it is possible for a seizure to be triggered. If Propofol 10 mg/ml is administered in combination with lidocaine, it should be noted that lidocaine may not be administered to patients with hereditary acute porphyria. Propofol 10 mg/ml does not have a vagolytic effect. The use was associated with the occurrence of bradycardia (slowing of the heart rate) with an occasionally severe outcome (cardiac arrest). Therefore, in situations where there is pre-existing high vagal tone or Propofol 10 mg/ml is administered with other drugs, which may decrease the heart rate, intravenous administration of an anticholinergic agent should be considered before or during anaesthesia with Propofol 10 mg/ml. During the use of Propofol 10 mg/ml for sedation for surgical and diagnostic procedures, the patient must be continually monitored for the first signs of a decrease in blood pressure, respiratory tract obstruction and oxygen deficiency. As is the case with other sedatives, spontaneous movements of the patient during surgical procedures may also occur with the use of Propofol 10 mg/ml for sedation. For procedures that require an immobile patient, these movements may jeopardise the success of the operation. Misuse and dependency on Propofol has been reported, primarily among healthcare personnel. As with all medications for general anaesthesia, it may not be used without securing an airway; otherwise, there is the risk of deadly respiratory complications. After the use of Propofol 10 mg/ml, it should be ensured that the patient has fully recovered from the anaesthesia prior to discharge. In individual cases, a phase of unconsciousness may occur after the operation in connection with the use of Propofol 10 mg/ml, which may be accompanied by increased muscle tone. The occurrence of this is dependent on whether or not the patient was previously awake. Even though the patient will spontaneously regain consciousness, an unconscious patient should be kept under intensive observation. The impairments caused by Propofol 10 mg/ml are usually not observed for longer than 12 hours. When explaining the effect of Propofol 10 mg/ml to the patient, the doctor should take into consideration the type of procedure, the concomitant medication, the age and the condition of the patient. The patient should be informed of the following, accordingly: that they should only return home when accompanied by another person, when manual activities or risky activities (e.g. operating a motor vehicle) can be carried out again, that taking other sedatives (e.g. benzodiazepine, opiates, alcohol) may prolong or increase the impairments. Studies with young animals as well as clinical data provide evidence that the repeated or long-term use of anaesthetics or sedatives in children under the age of 3 and in pregnant women in the last trimester could have negative effects on brain development in the child. The parents / legal guardians should discuss the benefits, risks, time and length of surgeries and other procedures requiring anaesthetics or sedatives with the doctor. Notes regarding intensive medical care by a doctor The use of infusions with Propofol emulsion for sedation as part of intensive care is associated with a series of metabolic disorders and organ failure, which may lead to death. In addition, combined occurrence of the following side effects has been reported: metabolic acidosis, rhabdomyolysis, hyperkalaemia, hepatomegaly, kidney failure, hyperlipidaemia, heart arrhythmia, Brugada-type ECG (saddle or tent shaped ST segment elevations in the right precordial leads [V1-V3] and concave T waves) and/or quickly progressing heart failure, which was usually not able to be treated with supportive inotropic therapeutic measures. The combination of these events is also called "Propofol infusion syndrome". These events were most frequently observed in patients with severe head injuries and in children with respiratory tract infections, which had received higher doses than is foreseen for adults for the purpose of sedation during intensive care. The following factors are believed to be significant risk factors for the development of this complication: Low oxygen saturation in tissue, severe neurological damage and/or sepsis; high doses of one or more of the following listed drugs: vasoconstrictors, steroids, inotropic agents and/or Propofol (usually at dosages of > 4 mg Propofol/kg of body mass per hour for more than 48 hours). The prescribing doctor should be aware of these possible undesired effects in patients with the risk factors described above and immediately discontinue the use of Propofol if signs of the symptoms described above occur. All sedatives and drugs, which are used during intensive care, should be titrated in such a way that optimal oxygen supply is ensured and the haemodynamic parameters remain optimised. In the case of these changes in therapy, patients with elevated intracranial pressure should receive an appropriate treatment that supports cerebral perfusion. The treating doctor should make sure that the recommended dosage of 4 mg Propofol/kg of body mass per hour is not exceeded to the greatest extent possible. Attention must be paid to lipid metabolism disorders or other disorders, as a result of which fat-containing emulsions should be used with caution. A check of the lipid metabolism parameters is recommended if Propofol 10 mg/ml is used in patients, where there is the suspicion of elevated blood lipid values. The administration of Propofol 10 mg/ml should be adjusted accordingly if the analysis indicates a lipid metabolism disorder. In the case of patients that are simultaneously receiving parenteral nutrition, the quantity of fat administered as a result of Propofol 10 mg/ml should be taken into account. 1.0 ml Propofol 10 mg/ml contains 0.1 g of fat. Additional information Patients with mitochondrial disorders should be treated with caution. These patients could experience an exacerbation of their disease if anaesthesia is used on them or a surgical procedure or intensive care treatment is administered. It is recommended that a normal body temperature be maintained for these patients, that carbohydrates by administered and that they be provided with sufficient fluids. The early signs of an exacerbation of a mitochondrial disorder and Propofol infusion syndrome may be similar. Propofol 10 mg/ml does not contain any antimicrobial preservation media, and the growth of microorganisms is facilitated due to its composition. a) Children The use of Propofol 10 mg/ml in newborns is not recommended, since this patient group has not been sufficiently evaluated.