From the Guidelines
The maximum rate of propofol infusion should not exceed 50 μg/kg/min, as recommended by the most recent and highest quality study 1. This recommendation is based on the clinical pharmacology of sedative medications, which suggests that propofol infusion rates above 50 μg/kg/min may increase the risk of adverse effects, such as respiratory depression, hypotension, and propofol infusion syndrome.
Key Considerations
- Propofol infusion rates should be individualized based on patient response, with careful titration to the minimum effective dose 1.
- Continuous monitoring of vital signs is essential, particularly blood pressure, as propofol can cause significant hypotension 1.
- Prolonged high-dose propofol infusions (>4 mg/kg/hr for >48 hours) carry a risk of propofol infusion syndrome, characterized by metabolic acidosis, rhabdomyolysis, and cardiovascular collapse 1.
- Propofol contains 0.1 g/mL of fat emulsion (1.1 kcal/mL), so nutritional implications should be considered for extended use 1.
- Dose reductions are typically necessary in elderly patients and those with significant cardiac, hepatic, or renal dysfunction 1.
Administration Guidelines
- Propofol should be delivered via a dedicated IV line using an infusion pump for precise control 1.
- The medication should be administered with caution in patients with baseline respiratory insufficiency and/or cardiovascular instability 1.
- Patients with egg or soybean allergies should be monitored closely for signs of allergic reactions, as propofol is dissolved in a 10% lipid emulsion containing egg lecithin and soybean oil 1.
From the Research
Maximum Rate of Propofol Infusion
The maximum rate of propofol infusion varies depending on the specific use case and patient population.
- For maintenance of anesthesia, a study found that an infusion rate of 0.15 mg/kg per minute can be considered as an approximate ED50 value 2.
- For sedation during surgery under regional anesthesia, a mean infusion rate of 1.74 mg/kg/hour was used 3.
- For outpatient general anesthesia, a continuous infusion of 150 micrograms/kg/min of propofol was used 4.
- A study investigating effective anesthesia induction doses using a wide range of infusion rates found that infusion rates greater than 80 mg/kg-1/h-1 resulted in rapid circulation and decreased excess induction time and dose 5.
- For sedative infusions during local and regional anesthesia, a variable-rate maintenance infusion of propofol equal to 265 +/- 185 mg/h was used 6.
Key Findings
- The maximum infusion rate of propofol is not explicitly stated in the provided studies, but the highest infusion rate mentioned is 300 mg/kg-1/h-1 5.
- The choice of infusion rate depends on the specific clinical context and patient population.
- Propofol infusion rates can vary widely depending on the desired level of sedation or anesthesia, as well as individual patient factors 2, 3, 4, 5, 6.