What is the dosage and administration of Propofol (propofol) for induction and maintenance of general anesthesia?

Propofol Dosage and Administration for General Anesthesia

For general anesthesia induction and maintenance, propofol should be administered at 1-2.5 mg/kg IV for induction (titrated to effect) followed by maintenance infusion of 50-200 mcg/kg/min, with dosage adjustments based on patient factors including age, comorbidities, and ASA status. 1

Induction Dosing

Adult Patients

• Standard healthy adults (ASA I-II, <55 years): 2-2.5 mg/kg IV titrated at approximately 40 mg every 10 seconds until onset of anesthesia 1
• Elderly, debilitated, or ASA III-IV patients: Reduced dosage of 1-1.5 mg/kg IV (approximately 20 mg every 10 seconds) 1
• Neurosurgical patients: Slower induction using 20 mg boluses every 10 seconds (typically 1-2 mg/kg total) 1
• Cardiac patients: 0.5-1.5 mg/kg administered slowly at approximately 20 mg every 10 seconds 1

Pediatric Patients

• Children 3-16 years (ASA I-II): 2.5-3.5 mg/kg IV 1
• ASA III-IV pediatric patients: Lower dosage recommended 1

Maintenance Dosing

Adult Patients

• Continuous infusion: 100-200 mcg/kg/min initially (first 10-15 minutes), then decreased by 30-50% during first half-hour 1
• Optimal maintenance rate: 50-100 mcg/kg/min to optimize recovery times 1
• Intermittent bolus method: 25-50 mg increments in response to clinical signs 1

Pediatric Patients

• Initial infusion rate: 200-300 mcg/kg/min immediately following induction 1
• After first half-hour: 125-150 mcg/kg/min typically needed 1
• Note: Younger pediatric patients may require higher maintenance rates than older children 1

Cardiac Anesthesia

• Primary agent: ≥100 mcg/kg/min with supplemental opioid analgesia 1
• With primary opioid: ≥50 mcg/kg/min to ensure amnesia 1
• Avoid: Rapid bolus induction in cardiac patients 1

Special Considerations

Pharmacokinetic Profile

• Onset of action: 30-45 seconds (one arm-brain circulation) 2
• Duration of effect: 4-8 minutes 2
• Metabolism: Rapid liver metabolism by conjugation to glucuronide and sulfate 2
• Elimination: Water-soluble compounds excreted by kidney 2

Patient-Specific Factors

• Factors altering pharmacokinetics: Weight, sex, age, and concomitant diseases 2
• Co-administered medications: Opioids, benzodiazepines, and other CNS depressants potentiate propofol's sedative effects 2, 1
• Contraindications: Allergies to egg, soy, or sulfites (present in propofol formulation) 2, 3

Monitoring Requirements

• Continuous monitoring of oxygen saturation, blood pressure, and cardiac activity 3
• Supplemental oxygen administration as needed 3
• Dedicated provider for patient monitoring during propofol sedation 3

Potential Adverse Effects

• Cardiovascular: Decreased cardiac output, systemic vascular resistance, and arterial pressure 2
• Respiratory: Respiratory depression responsive to dose reduction or interruption 2
• Pain on injection: Reported in up to 30% of patients 2, 3
• Apnea requiring assisted ventilation: Approximately 1 per 500-1000 procedures 3

Practical Administration Tips

• Avoid rapid bolus administration, especially in elderly, debilitated, or ASA III-IV patients 1
• For pediatric patients, minimize injection pain by using lidocaine pretreatment or administering via larger veins 1
• Titrate downward in absence of light anesthesia signs to avoid unnecessarily high rates 1
• For procedures longer than 30 minutes, consider reducing infusion rates by 30-50% after the first half-hour to prevent accumulation 3, 1

By following these dosing guidelines and considering patient-specific factors, propofol can provide effective induction and maintenance of general anesthesia with rapid, predictable emergence and minimal postoperative complications.