What is the maintenance dose of propofol (intravenous anesthetic) for a 200-pound patient?

From the Guidelines

The maintenance dose of propofol for a 200-pound (approximately 91 kg) patient is typically 5-50 μg/kg/min, which translates to about 0.45-4.55 mg/min, as recommended in the clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit 1.

Key Considerations

• The dose should be titrated based on clinical response, with adjustments made to achieve the desired level of sedation while monitoring vital signs.
• For procedural sedation, doses may be on the lower end of this range, while general anesthesia typically requires higher doses.
• Elderly patients, those with significant comorbidities, or hemodynamically unstable patients may require lower doses, starting at 5 μg/kg/min.
• Propofol works by enhancing GABA-mediated inhibition in the central nervous system, causing sedation and amnesia.

Monitoring and Administration

• During administration, continuous monitoring of blood pressure, heart rate, oxygen saturation, and depth of sedation is essential as propofol can cause dose-dependent hypotension and respiratory depression.
• The infusion should be delivered using a controlled infusion pump for accuracy, and the patient should have secure intravenous access.
• It is also important to be aware of the potential for propofol infusion syndrome (PRIS), which can occur with prolonged administration of high propofol doses (> 70 μg/kg/min) or even with low-dose infusions 1.

Potential Side Effects

• Propofol can cause pain on injection, hypotension, respiratory depression, hypertriglyceridemia, pancreatitis, allergic reactions, and PRIS.
• Deep sedation with propofol is associated with significantly longer emergence times than with light sedation 1.

From the FDA Drug Label

Adult Patients In adults, anesthesia can be maintained by administering propofol injectable emulsion by infusion or intermittent IV bolus injection The patient's clinical response will determine the infusion rate or the amount and frequency of incremental injections. Continuous Infusion Propofol injectable emulsion 100 mcg/kg/min to 200 mcg/kg/min administered in a variable rate infusion with 60% to 70% nitrous oxide and oxygen provides anesthesia for patients undergoing general surgery Maintenance by infusion of propofol injectable emulsion should immediately follow the induction dose in order to provide satisfactory or continuous anesthesia during the induction phase. During this initial period following the induction dose, higher rates of infusion are generally required (150 mcg/kg/min to 200 mcg/kg/min) for the first 10 to 15 minutes Infusion rates should subsequently be decreased 30% to 50% during the first half-hour of maintenance. Generally, rates of 50 mcg/kg/min to 100 mcg/kg/min in adults should be achieved during maintenance in order to optimize recovery times.

To calculate the maintenance dose of propofol for a 200-pound patient, we need to convert the weight from pounds to kilograms.

• 1 pound is equal to 0.453592 kilograms.
• So, 200 pounds is equal to 200 x 0.453592 = 90.7184 kilograms, which we can round to 91 kilograms for simplicity.

Given the recommended maintenance infusion rate of 50 mcg/kg/min to 100 mcg/kg/min, the dose for a 91-kilogram patient would be:

• 50 mcg/kg/min: 50 mcg/kg/min x 91 kg = 4550 mcg/min
• 100 mcg/kg/min: 100 mcg/min x 91 kg = 9100 mcg/min

Therefore, the maintenance dose of propofol for a 200-pound patient would be between 4550 mcg/min and 9100 mcg/min 2.

From the Research

Maintenance Dose of Propofol

The maintenance dose of propofol for a 200-pound patient is not explicitly stated in the provided studies. However, some studies provide information on the dosing of propofol for sedation:

• A study from 2025 3 mentions 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 to achieve the target sedation level.
• To calculate the dose for a 200-pound patient, we need to convert the weight from pounds to kilograms. Since 1 pound is approximately equal to 0.45 kilograms, a 200-pound patient would weigh approximately 90 kilograms.
• Using the dose from the 2025 study 3, the maintenance infusion of propofol would be approximately 0.3 mg/kg/h * 90 kg = 27 mg/h, with a maximum dose of 4.0 mg/kg/h * 90 kg = 360 mg/h.

Key Considerations

Some key considerations when administering propofol include:

• Monitoring the patient's vital signs and adjusting the dose as needed to achieve the target sedation level 3
• Being aware of the potential for adverse events, such as hypotension and respiratory depression 4, 5
• Using strict aseptic technique when handling the propofol to prevent accidental extrinsic microbial contamination 4

Additional Information

Additional information on the use of propofol for sedation can be found in the provided studies, including:

• A review of the use of propofol in intensive care sedation of adults 4
• An update on the use of propofol in anesthesia and conscious sedation 5
• A scoping review of patient-maintained propofol sedation for adult patients undergoing surgical or medical procedures 6
• A clinical practice guideline for emergency department procedural sedation with propofol 7