Pofol should be used with caution in patients of ASA grades 3 and 4, debilitated patients and elderly patients. Patients with circulatory or respiratory impairment, hypovolaemic patients; renal or hepatic impairment; epileptics or with epileptic history; drug dependency and hypersensitivity history; with disorders of fat metabolism (primary leucosis, diabetic hyperlipidemia, pancreatitis, etc) or in other conditions where lipid emulsions must be used cautiously. [It is recommended that blood lipid levels be monitored when Pofol is administered to patients thought to be at particular risk of fat overload. Administration of Pofol should be adjusted appropriately if the monitoring indicates that fat is being inadequately cleared from the body. If the patient is receiving other IV lipid concurrently, a reduction in quantity should be made in order to take account of the amount of lipid infused as part of the Pofol formulation; Pofol 10 mg (1 mL) contains approximately 0.1 g of fat].
General: For anaesthesia, patients should be abstained from food as a rule and pre-anaesthetic medication should be carried out.
During anaesthesia, respiratory and circulatory system should be observed.
The depth of anaesthesia is considered as lowest depth needed for operation or test.
Pofol should be given by those trained in anaesthesia or intensive care and after administration, the anaesthesiologist should observe the state of patients until completely awakened.
Before anaesthesia, facilities for artificial ventilation eg, aerobic respiratory apparatus, intubatory apparatus, aspirator, etc should be available.
Patients must not have alcohol at least 8 hrs before/after administration of Pofol.
In case Pofol is used to provide sedation for ventilated patients undergoing intensive care, it should be limited for a period of up to 3 days.
Sufficient recovery time should be given to patients after general anaesthesia until the recovery is sure.
The risk of relative vagal overactivity may be increased because Pofol lacks vagolytic activity; it has been associated with reports of bradycardia, occasionally profound and also asystole. The IV administration of an anticholinergic agent before induction or during maintenance of anaesthesia should be considered, especially in situations where vagal time is likely to predominate or when Pofol is used in conjunction with other agents likely to cause bradycardia.
Effects on the Ability to Drive or Operate Machinery: Patients should be advised that performance of skilled tasks eg, driving may be impaired for some time after general anaesthesia.
Use in the elderly: As with other IV anaesthetic agents, caution should be applied in elderly patients with renal or hepatic impairment, baroreceptor reflex depression.