What is the recommended dosage and usage of Propofol (propofol) for inducing and maintaining anesthesia or sedation?

Propofol Dosage and Usage for Anesthesia and Sedation

For adult patients requiring anesthesia or sedation, propofol should be administered at 2-2.5 mg/kg for induction in healthy adults under 55 years (ASA I-II), followed by maintenance infusion of 50-100 mcg/kg/min, with reduced dosing of 1-1.5 mg/kg for induction in elderly or debilitated patients. 1

Induction of General Anesthesia

Adult Patients

• Most adults under 55 years classified as ASA-PS I or II require 2-2.5 mg/kg of propofol for induction when unpremedicated or when premedicated with oral benzodiazepines or intramuscular opioids 1
• For induction, propofol should be titrated (approximately 40 mg every 10 seconds) against patient response until clinical signs show onset of anesthesia 1
• The amount of intravenous opioid and/or benzodiazepine premedication will influence the response to propofol induction 1

Elderly, Debilitated, or ASA-PS III or IV Patients

• Most elderly, debilitated, or ASA-PS III or IV patients require approximately 1-1.5 mg/kg (approximately 20 mg every 10 seconds) for induction 1
• Rapid bolus should be avoided as it increases the likelihood of undesirable cardiorespiratory depression including hypotension, apnea, and airway obstruction 1

Pediatric Patients

• Most patients aged 3-16 years classified as ASA-PS I or II require 2.5-3.5 mg/kg for induction 1
• Younger pediatric patients may require higher induction doses than older pediatric patients 1
• Lower dosage is recommended for pediatric patients classified as ASA-PS III or IV 1

Special Populations

• For neurosurgical patients, slower induction is recommended using boluses of 20 mg every 10 seconds 1
• For cardiac patients, a slow rate of approximately 20 mg every 10 seconds until induction onset (0.5-1.5 mg/kg) should be used 1

Maintenance of General Anesthesia

Adult Patients

• Maintenance can be achieved by continuous infusion or intermittent IV bolus injection 1
• For continuous infusion: 50-100 mcg/kg/min in adults during maintenance to optimize recovery times 1
• During the initial period following induction, higher rates (150-200 mcg/kg/min) are generally required for the first 10-15 minutes 1
• Infusion rates should subsequently be decreased 30-50% during the first half-hour of maintenance 1
• For intermittent bolus: Increments of 25-50 mg may be administered when changes in vital signs indicate response to surgical stimulation 1

Pediatric Patients

• Maintenance by infusion at 200-300 mcg/kg/min should immediately follow the induction dose 1
• Following the first half-hour, infusion rates of 125-150 mcg/kg/min are typically needed 1
• Younger pediatric patients may require higher maintenance rates than older pediatric patients 1

Monitored Anesthesia Care (MAC) Sedation

Adult Patients

• For MAC sedation, rates should be individualized and titrated to clinical response 1
• Most patients require 25-75 mcg/kg/min 1
• For initiation of MAC sedation, either infusion or slow injection method may be utilized 1
• With infusion method: 100-150 mcg/kg/min for 3-5 minutes and titrating to desired effect 1
• With slow injection method: approximately 0.5 mg/kg over 3-5 minutes 1

Pharmacology and Properties

• Propofol is a hypnotic with minimal analgesic effect that produces sedation and amnesia at subhypnotic doses 2, 3
• It has a rapid onset of action (30-45 seconds) and short duration of effect (4-8 minutes) 3
• Propofol is highly lipophilic, allowing rapid passage through the blood-brain barrier 3
• It is rapidly metabolized in the liver by conjugation to glucuronide and sulfate, producing water-soluble compounds excreted by the kidneys 3

Adverse Effects and Precautions

• Cardiovascular effects include decreased cardiac output, systemic vascular resistance, and arterial pressure 3, 4
• Pain on injection occurs in up to 30% of patients receiving an intravenous bolus 3
• Dose-dependent respiratory depression can occur, particularly when combined with opioids 3, 4
• Current formulation contains 1% propofol, 10% soybean oil, 2.25% glycerol, and 1.2% purified egg phosphatide; should be avoided in individuals with allergies to eggs, soy, or sulfites 3
• Propofol should be used with extreme caution in patients with pulmonary hypertension due to potential hemodynamic instability 4
• Prolonged high-dose administration (>4 mg/kg/h for >48 hours) has been associated with propofol infusion syndrome, characterized by metabolic acidosis, rhabdomyolysis, arrhythmias, and organ failure 5

Administration Guidelines

• Shake well before use 1
• When administering by infusion, syringe or volumetric pumps are recommended to provide controlled infusion rates 1
• Infusion rates should always be titrated downward in the absence of clinical signs of light anesthesia 1
• Allow sufficient time between doses to assess peak effect before subsequent administration 4
• Be prepared for rapid intervention if hemodynamic compromise occurs 4

Propofol has gained popularity due to its rapid onset and recovery even after prolonged use, making it suitable for both induction and maintenance of anesthesia as well as sedation in various clinical settings 6, 7.