Why is propofol controversial and widely used in healthcare?

Propofol is primarily used as a sleeping anesthetic, and its rapid metabolism and ease of administration make it useful in the medical field. However, it requires strict management due to its addictive nature and potential for side effects. Although it’s controversial due to its abuse by some, it’s a drug that’s proven to be safe and useful when used in the right amounts.

 

Every once in a while, news of a popular celebrity receiving a propofol injection sparks controversy. But at this very moment, propofol injections are probably being administered by many doctors in many hospitals to many patients. So why is propofol so controversial and yet so widely used by patients?
Propofol is an intravenous anesthetic that is commonly used as a “sleeping pill”. The first way propofol works in the body as a sleeping anesthetic is in the brain. The human brain is made up of numerous ‘association nerves’, which we call ‘brain cells’. These brain cells are responsible for perceiving sensations and making connections between them, which are mediated by ‘neurotransmitters’, and the part of the brain cell that receives these substances is called a ‘receptor’. It is these receptors that are commonly affected by general anesthetics, and the receptors that propofol specifically works on are the GABAA receptors. When propofol is administered into the body and acts on the GABAA receptors in the brain, it blocks neurotransmitters from traveling between brain cells. As a result, information about sensations is not transmitted between brain cells, resulting in a lack of sensory perception. In other words, the brain’s role is temporarily inhibited, preventing you from feeling pain. This mechanism is what makes propofol so effective as a sedative, and it’s commonly used in surgery to “induce and maintain general anesthesia”. Common examples we see around us are sleep anesthesia in endoscopy or simple plastic surgery.
Among medical anesthetics, propofol has many useful applications. First, it is administered intravenously, which makes it simple to administer, and its rapid metabolism and distribution in the body makes it ideal for short-term anesthesia. For example, in sleep endoscopy, the patient falls asleep as soon as the drug is administered and wakes up after a short period of time. Second, propofol is rapidly metabolized in the body and does not accumulate, so there is no need to increase the dose, and it can be administered as needed to maintain anesthesia for a long time. Finally, the depth of anesthesia is easy to control and recovery from anesthesia is quick. Thanks to these benefits, propofol has been widely used since 1992 in more than 50 countries around the world, including South Korea.
However, propofol should only be administered under strict supervision, and its use by the general public is prohibited. Even for doctors, it’s considered illegal to administer more than the proper amount. In most countries, propofol is classified as a psychotropic drug and is strictly controlled because of its side effects and dependence. Due to its ability to block the movement of neurotransmitters, an overdose of propofol can inhibit signals related to breathing, causing apnea and a drop in blood pressure. Other side effects include headaches and convulsions. Propofol also has the potential to cause hallucinogenic effects such as insomnia, fatigue, anxiety, and mood elevation, which can lead to addiction. Because of these side effects and dependence issues, propofol should only be administered under the control of a physician in appropriate doses and with professional management of any temporary side effects that may occur after administration.
Propofol is by no means a problematic drug. Its safety has been proven in clinical trials and its usefulness has been recognized by its widespread use in many medically advanced countries. This means that when used in the right doses, it produces the required level of anesthesia without causing any side effects. However, it’s the misuse and abuse of this drug by some that has become a problem. To use this useful drug wisely, it’s important to recognize its ambivalence and avoid misusing it. Doctors should also ensure that patients are given the right dosage and watch out for possible side effects. Furthermore, the social controversy surrounding propofol is another barrier to overcome, as there are people in society who are unable to use it properly. We need to take this as an opportunity to develop more useful and safer drugs.