What is the recommended dosage of propofol (2,6-diisopropylphenol) for sedation?

Propofol Dosage for Sedation

For procedural sedation, propofol should be administered with an initial bolus of 1 mg/kg followed by 0.5 mg/kg supplements as needed, with at least 20-30 seconds between doses. 1

Adult Dosing Recommendations

Initial Dosing

• For adults requiring procedural sedation, initial bolus doses range from 10-60 mg, with most protocols recommending 20-40 mg 1
• When combined with opioids or benzodiazepines (combination propofol), lower initial doses of 10-20 mg can be effective 1
• For continuous infusion, start at 5 mcg/kg/min (0.3 mg/kg/h) and titrate up by increments of 5-10 mcg/kg/min with at least 5 minutes between adjustments 2

Maintenance Dosing

• For bolus dosing during procedures, administer 10-20 mg every 20-30 seconds as needed to maintain desired sedation level 1
• For continuous infusion, most adult patients require 5-50 mcg/kg/min (0.3-3 mg/kg/h) 2
• For moderate sedation during procedures, an infusion rate of 25-50 mcg/kg/min is recommended 3
• For deep sedation, higher rates may be required, but should not exceed 4 mg/kg/hour unless benefits outweigh risks 2

Pediatric Dosing

• For children, initial bolus of 1 mg/kg followed by 0.5 mg/kg supplements as needed 1
• Mean doses in pediatric studies ranged from 1-3.3 mg/kg for procedural sedation 1, 3

Combination Therapy Considerations

• When combined with opioids and/or benzodiazepines, propofol doses can be significantly reduced 1
• Combination therapy with midazolam can reduce propofol requirements by up to 35% 4
• For moderate sedation with combination therapy, propofol doses of 35-70 mg for endoscopic procedures and 65-100 mg for colonoscopy are typically effective 1

Special Considerations

Patient Factors Affecting Dosing

• Elderly, debilitated, and ASA-PS III or IV patients require lower doses due to exaggerated hemodynamic and respiratory responses 2
• Patients with compromised myocardial function, intravascular volume depletion, or abnormally low vascular tone (e.g., sepsis) are more susceptible to hypotension and require dose reduction 2
• Patients who have received large doses of narcotics require lower propofol doses 2

Monitoring Requirements

• Continuous monitoring of heart rate, blood pressure, and pulse oximetry is essential 1
• Supplemental oxygen administration is recommended in most protocols 1
• A dedicated healthcare provider should be responsible for monitoring the patient and administering propofol 1

Common Pitfalls and Caveats

• Propofol has no analgesic properties; consider adding analgesics for painful procedures 1
• Respiratory depression and hypotension are dose-dependent complications; titrate carefully 5
• Pain on injection occurs in up to 30% of patients 1
• Propofol is contraindicated in patients with allergies to egg, soy, or sulfite 1
• Rapid administration can lead to profound hypotension; administer slowly and titrate to effect 2
• The FDA label states propofol "should be administered only by persons trained in the administration of general anesthesia," though its use has expanded to procedural sedation 1

Evidence Quality Assessment

The guidelines from the American Gastroenterological Association (2007) and the American College of Emergency Physicians (2005) provide consistent recommendations for propofol dosing in procedural sedation. These are supported by multiple observational studies showing safety and efficacy with the recommended dosing regimens. The FDA drug label provides additional guidance for continuous infusion dosing in ICU settings.