Propofol Dosage for Sedation
For adult procedural sedation, administer propofol with initial bolus doses of 20-40 mg (range 10-60 mg), followed by maintenance doses of 10-20 mg every 20-30 seconds as needed, while for pediatric patients, use an initial bolus of 1 mg/kg followed by 0.5 mg/kg supplements as needed. 1
Adult Dosing
Initial Dosing
- For adults requiring procedural sedation, initial bolus doses typically range from 10-60 mg, with most protocols recommending 20-40 mg 1
- When combined with opioids or benzodiazepines, lower initial doses of 10-20 mg are effective due to synergistic effects 1
- For mechanically ventilated ICU patients, initiate sedation with a continuous infusion at 5 mcg/kg/min (0.3 mg/kg/h) and titrate by increments of 5-10 mcg/kg/min 2
Maintenance Dosing
- For bolus maintenance during procedures, administer 10-20 mg every 20-30 seconds as needed 1
- For continuous infusion in ICU patients, most adults require 5-50 mcg/kg/min (0.3-3 mg/kg/h) 2
- Administration should not exceed 4 mg/kg/hour unless benefits outweigh risks 2
- For combination therapy during endoscopic procedures, propofol doses of 35-70 mg for upper endoscopy and 65-100 mg for colonoscopy are typically effective 1
Pediatric Dosing
Initial Dosing
- For children, an initial bolus of 1 mg/kg is recommended 1, 3
- Mean doses in pediatric studies range from 1-3.9 mg/kg for procedural sedation 3, 4
Maintenance Dosing
- Supplement with 0.5 mg/kg boluses as needed to maintain sedation 1, 4
- For MRI sedation in children, after initial bolus, maintenance with propofol 5 mg/kg/h has shown effectiveness with minimal adverse events 5
- Target BIS (Bispectral Index) score of 45 has been shown effective for pediatric procedural sedation 4
Special Considerations
Combination Therapy
- When combined with opioids and/or benzodiazepines, propofol doses can be significantly reduced 1
- For MAC (Monitored Anesthesia Care) in premedicated outpatients, a propofol infusion of 25-50 mcg/kg/min with alfentanil 0.2-0.4 mcg/kg/min provides effective sedation 6
- Premedication with midazolam 2 mg IV allows for lower propofol requirements 6
Delivery Methods
- Target Controlled Infusion (TCI) systems may provide more stable sedation with fewer episodes of hypoxia compared to intermittent bolus administration 7
- Initial target effect-site concentration of 4 mcg/ml followed by maintenance of 2.5 mcg/ml has shown effectiveness for endoscopic procedures 7
Monitoring Requirements
- Continuous monitoring of heart rate, blood pressure, and pulse oximetry is essential 1, 2
- Supplemental oxygen administration is recommended in most protocols 1
- A dedicated healthcare provider should be responsible for monitoring the patient and administering propofol 1
- Allow sufficient time between doses to assess peak effect before subsequent administration 8
Common Pitfalls and Caveats
- Propofol has no analgesic properties; consider adding analgesics for painful procedures 1, 9
- Dose-dependent hypotension is common, particularly in volume-depleted patients 8, 9
- Pain on injection occurs in up to 30% of patients 1
- Propofol is contraindicated in patients with allergies to egg, soy, or sulfite 1
- Elderly, debilitated, and ASA-PS III or IV patients may have exaggerated hemodynamic and respiratory responses to rapid bolus doses 2
- Reduce propofol doses in patients who have received large doses of narcotics 2