From the Guidelines
The maintenance dose of propofol for sedation is 5-50 μg/kg/min, as indicated in the most recent and highest quality study 1. This dose should be titrated to the desired level of sedation based on patient response, with the goal of using the minimum effective dose to achieve the target sedation level. Some key points to consider when administering propofol for sedation include:
- Starting at the lower end of the dosing range and adjusting upward as needed
- Using caution in elderly, debilitated, or hemodynamically unstable patients, who may require lower doses
- Continuously monitoring vital signs, oxygen saturation, and sedation level during propofol administration
- Being aware of the potential for propofol infusion syndrome, characterized by metabolic acidosis, rhabdomyolysis, and cardiac dysfunction, particularly with prolonged infusions at high doses
- Understanding that propofol works by enhancing GABA-mediated inhibition in the central nervous system, resulting in dose-dependent sedation, and has a rapid onset and short duration of action, making it suitable for procedures requiring frequent neurological assessments. It's also important to note that propofol can cause dose-dependent respiratory depression and hypotension, and can precipitate allergic reactions in patients with egg or soybean allergies 1. Overall, the maintenance dose of propofol for sedation should be individualized to each patient's needs and response, with careful attention to potential side effects and complications.
From the FDA Drug Label
When propofol injectable emulsion is administered for MAC sedation, rates of administration should be individualized and titrated to clinical response In most patients, the rates of propofol injectable emulsion administration will be in the range of 25 mcg/kg/min to 75 mcg/kg/min.
The maintenance dose of propofol for sedation is 25 mcg/kg/min to 75 mcg/kg/min 2.
- The dose should be individualized and titrated to clinical response.
- Slow infusion or slow injection techniques are preferable over rapid bolus administration.
- In the elderly, debilitated, or ASA-PS III or IV patients, rapid bolus dose administration should not be used for MAC sedation.
From the Research
Maintenance Dose of Propofol for Sedation
The maintenance dose of propofol for sedation can vary depending on the patient population and the specific clinical setting.
- In critically ill patients receiving mechanical ventilation, a maintenance infusion of propofol of 0.3 mg/kg/h, titrated up to a maximum of 4.0 mg/kg/h or down by 0.3 mg/kg/h, can be used to achieve a target sedation level 3.
- The depth of sedation increases in a dose-dependent manner, and the administration of propofol should be titrated to achieve the desired level of sedation 4.
- Propofol provides satisfactory sedation and is associated with good haemodynamic stability, but it can induce a dose-dependent decrease in blood pressure and heart rate 5, 4.
Factors Affecting Propofol Dosing
Several factors can affect the dosing of propofol, including:
- Patient age: Advanced age is associated with increased susceptibility to acute adverse effects of propofol, and lower doses may be required in older adults 6.
- Epidural lidocaine administration: Epidural and intravenous lidocaine can reduce the dose of propofol required to induce general anesthesia 7.
- Sensory block height: Higher sensory epidural block can reduce propofol requirements 7.
Comparison with Other Sedatives
Propofol has been compared with other sedatives, such as midazolam, in several studies.
- Propofol provides similar or better sedation than midazolam, with a faster recovery time and more predictable emergence from sedation 5, 4.
- Remimazolam besylate, a novel ultra-short-acting benzodiazepine, is being studied as a potential alternative to propofol for short-term sedation in critically ill patients 3.