What is the recommended intubating dose of propofol (intravenous anesthetic agent)?

Intubating Dose of Propofol

For standard adult patients (ASA I-II, <55 years), the recommended intubating dose of propofol is 1-2.5 mg/kg IV administered as a slow bolus over 20-30 seconds. 1

Dosing Based on Patient Factors

• Standard healthy adults (ASA I-II, <55 years):

  • Initial dose: 1-2.5 mg/kg IV 1
  • Typical effective dose: 2-2.5 mg/kg IV 2

• Elderly, debilitated, or ASA III-IV patients:

  • Reduced dose: 1-1.5 mg/kg IV 2
  • Administer approximately 20 mg every 10 seconds to titrate effect 2

• Hemodynamically compromised patients:

  • Further reduced dose: 0.5-1 mg/kg IV 1
  • Careful titration required to avoid cardiovascular depression 1

• Pediatric patients (3-16 years):

  • ASA I-II: 2.5-3.5 mg/kg IV 2
  • ASA III-IV: Lower dosage recommended 2
  • Younger children may require higher doses than older children 2

Administration Technique

• Administer as a slow bolus over 20-30 seconds 1
• Wait 30-45 seconds to evaluate effect before proceeding with intubation 1
• Avoid rapid bolus administration, especially in elderly or compromised patients 2
• Have additional doses readily available if intubation proves difficult 1

Combination with Other Medications

When combined with opioids or other sedatives, propofol requirements are reduced:

• Fentanyl (3 μg/kg) given 3 minutes before propofol reduces the required propofol dose to 3 mg/kg for acceptable intubation conditions in 80% of pediatric patients 3
• Remifentanil (2.4 μg/kg) combined with propofol (2 mg/kg) provides acceptable intubating conditions in 95% of patients without neuromuscular blockade 4

Potential Complications and Precautions

• Cardiovascular effects: Dose-dependent hypotension is common, particularly with rapid administration 1, 2
• Respiratory depression: Can cause apnea, particularly at higher doses 2
• Special populations: Preterm neonates are particularly sensitive to propofol's hypotensive effects, with significant blood pressure drops reported even at 1 mg/kg 5

Monitoring

• Continuous monitoring of oxygen saturation, blood pressure, and cardiac activity is mandatory 1
• Have airway equipment and resuscitation medications immediately available 1
• Supplemental oxygen should be administered before induction 1

Important Considerations

• Propofol has no analgesic properties, so patients may require deeper sedation for painful procedures 1
• Underdosing increases the risk of awareness during intubation 1
• Propofol suppresses airway reflexes more effectively than other induction agents, which may be advantageous if intubation fails 1
• Avoid prolonged high-dose infusions (>4-5 mg/kg/h for >48h) due to risk of propofol infusion syndrome 6

By following these dosing guidelines and monitoring protocols, propofol can provide effective and safe conditions for endotracheal intubation while minimizing adverse effects.