What is the recommended dose of propofol (generic name) for intubation in a 170cm and 87kg female?

Propofol Dosing for Intubation in a 170cm, 87kg Female

The recommended initial dose of propofol for intubation in a 170cm, 87kg female is 1-2 mg/kg based on lean body weight, with an initial bolus of approximately 100-150 mg. 1, 2

Dosing Considerations

Weight-Based Calculation

• For a 170cm, 87kg female patient:
  • Initial dose: 1-2 mg/kg (based on lean body weight rather than total body weight)
  • Starting with 1.5 mg/kg is reasonable in this patient 1
  • This equates to approximately 100-150 mg as initial bolus

Patient-Specific Factors

• Age affects dosing requirements:
  • If patient is >54 years old: reduce dose to approximately 1.66 mg/kg 1
  • If patient is <54 years old: standard dose of approximately 1.99 mg/kg 1
• Hemodynamic stability:
  • If patient has cardiovascular instability: use slower administration (20 mg every 10 seconds) 1
  • Monitor for hypotension, which occurs in up to 84% of patients 2

Administration Technique

Bolus Administration

• Administer initial bolus over 45-60 seconds to minimize hypotension 3
• For rapid sequence intubation:
  • Consider co-administration with an opioid (e.g., remifentanil 4 μg/kg) for optimal intubating conditions 3
  • This combination provides excellent intubation conditions in 95% of patients

Supplemental Dosing

• If needed, administer additional doses of 0.5 mg/kg 2
• Allow 20-30 seconds between supplemental doses to assess effect 2
• Total dose typically ranges from 2-3 mg/kg for complete induction 1

Monitoring and Safety

Cardiovascular Monitoring

• Expect transient decrease in blood pressure (10-30% from baseline) 2
• Have vasopressors readily available
• Monitor heart rate for bradycardia, which occurs in approximately 6% of patients 2

Respiratory Monitoring

• Be prepared for potential respiratory depression:
  • Approximately 5-7% of patients may experience oxygen desaturation below 90% 2
  • 1-3% may require brief bag-mask ventilation 2
  • Have airway equipment immediately available

Special Considerations

Medication Interactions

• If patient has received premedication with opioids or benzodiazepines:
  • Reduce propofol dose by 25-50% 1
  • These agents potentiate the sedative effects of propofol

Contraindications

• Avoid in patients with allergies to egg, soy, or sulfite 2
• Not contraindicated in patients with sulfonamide allergy 2

Risk of Propofol Infusion Syndrome

• For intubation only (single dose), this is not a concern
• Only becomes relevant with prolonged infusions >48 hours at rates >4 mg/kg/hr 4

Conclusion

For this 87kg female patient, an initial propofol dose of 100-150 mg administered over 45-60 seconds represents a safe and effective approach for intubation. Be prepared to administer additional doses of 40-50 mg if needed, while closely monitoring hemodynamic and respiratory parameters.