From the FDA Drug Label
Administration should not exceed 4 mg/kg/hour unless the benefits outweigh the risks
- The maximum dose of propofol is 4 mg/kg/hour unless the benefits outweigh the risks 1
- This dose should be individualized and titrated to the desired effect, according to clinically relevant factors including the patient's underlying medical problems, preinduction and concomitant medications, age, ASA-PS classification, and level of debilitation of the patient.
From the Research
The maximum dose of propofol is not strictly defined, but for induction of general anesthesia, the typical maximum dose is 2.5 mg/kg, as supported by the most recent study 2. For maintenance of anesthesia, propofol can be administered at 100-200 mcg/kg/min (6-12 mg/kg/hr). For sedation in ICU settings, doses typically range from 5-50 mcg/kg/min (0.3-3 mg/kg/hr), while procedural sedation usually requires 25-75 mcg/kg/min (1.5-4.5 mg/kg/hr). These doses should be titrated to clinical effect and reduced in elderly, debilitated, or hypovolemic patients. There is no absolute maximum dose, as propofol is titrated to effect while monitoring hemodynamic parameters. Higher doses increase the risk of hypotension, respiratory depression, and propofol infusion syndrome (with prolonged high-dose infusions exceeding 4 mg/kg/hr for >48 hours) 3. Propofol is highly lipophilic and rapidly redistributes from the central nervous system, allowing for quick onset and recovery, but accumulates with prolonged administration, potentially extending recovery time. The combined use of propofol and other sedatives, such as dexmedetomidine, may provide cardiovascular stability with decreased adverse effects 4. However, the optimal dosing strategy for propofol should be individualized based on the patient's response and clinical context, as suggested by studies on pharmacokinetics and pharmacodynamics 5, 6.
Some key points to consider when using propofol include:
- Monitoring hemodynamic parameters, such as blood pressure and heart rate, to adjust the dose accordingly
- Reducing the dose in elderly, debilitated, or hypovolemic patients to minimize the risk of adverse effects
- Being aware of the potential for propofol infusion syndrome with prolonged high-dose infusions
- Considering the use of alternative sedatives or combination therapy to optimize patient outcomes.
Overall, the use of propofol requires careful consideration of the patient's individual needs and clinical context to minimize the risk of adverse effects and optimize outcomes.