What is the recommended dose for propofol (intravenous anesthetic) sedation?

Propofol Sedation Dosing Guidelines

For procedural sedation, propofol should be initiated with an initial bolus of 10-60 mg intravenously, followed by additional boluses of 10-20 mg administered at minimum intervals of 20-30 seconds, with dosing individualized based on patient response. 1

Adult Dosing Recommendations

Initial Dosing

• Standard adult patients (ASA I-II, <55 years): 1-2.5 mg/kg 1, 2
• Elderly, debilitated, or ASA III-IV patients: 1-1.5 mg/kg (approximately 20 mg every 10 seconds) 2
  • Avoid rapid bolus administration in these patients to prevent cardiovascular depression 2

Maintenance Dosing

• Nurse-Administered Propofol Sedation (NAPS):
  • Additional boluses of 10-20 mg with minimum 20-30 seconds between doses 1
  • Mean doses for endoscopic procedures:
    • EGD: 72-245 mg
    • Colonoscopy: 94-287 mg 1
• Continuous infusion for ICU sedation:
  • Start at 5 mcg/kg/min (0.3 mg/kg/hr)
  • Titrate by increments of 5-10 mcg/kg/min
  • Typical maintenance: 5-50 mcg/kg/min (0.3-3 mg/kg/hr)
  • Maximum: 4 mg/kg/hour unless benefits outweigh risks 2

Pediatric Dosing Recommendations

• Initial bolus: 1-2.5 mg/kg 2, 3
• Maintenance:
  • Intermittent dosing: Titrate to effect
  • Continuous infusion: Start at 2.5 mg/kg/hr and adjust as needed 3
• Children 3-16 years (ASA I-II): 2.5-3.5 mg/kg for induction 2

Combination Approaches

Propofol with Other Medications

• Propofol + Opioid + Benzodiazepine ("Combination Propofol"):
  • Reduces propofol requirements significantly
  • EGD: 35-70 mg (vs. 107-245 mg with propofol alone)
  • Colonoscopy: 65-100 mg (vs. 144-287 mg with propofol alone) 1
• Propofol + Ketamine:
  • Addition of low-dose ketamine (0.25-0.5 mg/kg) reduces propofol requirements (0.28 vs. 0.40 mg/kg/min) 4
  • Results in shorter recovery times (17 vs. 22 minutes) 4

Monitoring Requirements

• Vital signs: Heart rate, blood pressure, pulse oximetry 1
• Supplemental oxygen: Recommended for most protocols 1
• Personnel: Trained provider dedicated to monitoring the patient 1

Important Safety Considerations

• Cardiovascular effects: Propofol decreases cardiac output, systemic vascular resistance, and arterial pressure 1, 2
• Respiratory depression: Occurs dose-dependently but responds rapidly to dose reduction 1, 2
• Contraindications: Allergies to egg, soy, or sulfite components 1, 2
• Pain on injection: Reported in up to 30% of patients; can be minimized with lidocaine 2
• Potentiation: Other CNS depressants (opioids, benzodiazepines) potentiate propofol's sedative effects 2

Clinical Pearls

• Propofol has no analgesic properties, so patients may require deeper sedation for painful procedures 1
• Recovery from propofol is typically rapid due to its short half-life 1, 5
• The rate of clinically important events (apnea requiring assisted ventilation) is approximately 1 per 500-1000 procedures 1
• When using propofol alone, larger doses are required for adequate sedation compared to combination approaches 1
• For brief procedures, propofol alone may be preferred due to faster recovery, while combination approaches may be better for longer procedures requiring less profound sedation 1, 5

Propofol dosing must be carefully titrated to the desired level of sedation while monitoring for adverse effects. The experience with gastroenterologist-directed administration of propofol now exceeds 200,000 patient experiences with no reported mortalities, demonstrating its safety profile when used appropriately 1.