What is the maintenance dose of propofol (2,6-diisopropylphenol) for sedation?

Maintenance Dose of Propofol

For maintenance sedation, propofol should be administered at 50-100 mcg/kg/min (3-6 mg/kg/h) for general anesthesia, 25-75 mcg/kg/min for moderate sedation (MAC), and 5-50 mcg/kg/min (0.3-3 mg/kg/h) for ICU sedation, with the specific rate determined by clinical context and patient factors. 1

General Anesthesia Maintenance

Standard maintenance infusion rates:

• Initial maintenance: 150-200 mcg/kg/min for the first 10-15 minutes following induction 1
• Subsequent maintenance: Decrease by 30-50% after the initial period, targeting 50-100 mcg/kg/min to optimize recovery 1
• When propofol is the primary agent: Maintenance rates should not be less than 100 mcg/kg/min, supplemented with continuous opioid administration 1
• When opioid is the primary agent: Propofol maintenance rates should not be less than 50 mcg/kg/min 1

Pediatric patients (≥2 months):

• Initial maintenance: 200-300 mcg/kg/min immediately following induction 1
• After first 30 minutes: 125-150 mcg/kg/min typically needed 1
• Younger children require higher maintenance rates than older children 1

Monitored Anesthesia Care (MAC) Sedation

For moderate sedation during procedures:

• Typical range: 25-75 mcg/kg/min (1.5-4.5 mg/kg/h) 1
• Initiation: 100-150 mcg/kg/min for 3-5 minutes, then titrate down 1
• Variable rate infusion is preferable over intermittent boluses 1

Endoscopic sedation (nurse-administered):

• Mean doses: 107-245 mg total for EGD, 144-287 mg total for colonoscopy 2
• Alternative lower-dose approach: Mean 72 mg for EGD, 94 mg for colonoscopy when targeting moderate rather than deep sedation 2

ICU Sedation

For mechanically ventilated patients:

• Initiation: Start at 5 mcg/kg/min (0.3 mg/kg/h) 1
• Titration: Increase by 5-10 mcg/kg/min increments every 5 minutes minimum until desired sedation achieved 1
• Maintenance range: 5-50 mcg/kg/min (0.3-3 mg/kg/h) for most patients 1
• Maximum safe dose: Do not exceed 4 mg/kg/h (67 mcg/kg/min) unless benefits outweigh risks 1

Critical warning: Doses >70 mcg/kg/min for >48 hours increase risk of Propofol Infusion Syndrome (PRIS), characterized by metabolic acidosis, rhabdomyolysis, arrhythmias, and up to 33% mortality 3, 4

Palliative Sedation

For refractory symptoms at end of life:

• Loading dose: 20 mg 2
• Maintenance infusion: 50-70 mg/h 2, 5

Special Population Adjustments

Elderly, debilitated, or ASA-PS III/IV patients:

• Avoid rapid boluses entirely 1
• Reduce maintenance rates by approximately 30-50% from standard dosing 1
• These patients have exaggerated hemodynamic and respiratory responses 1

CYP2B6 poor metabolizers:

• Reduce maintenance infusion to 25 mcg/kg/min (approximately 50% reduction from standard 50-100 mcg/kg/min range) 3

Patients receiving concurrent opioids:

• Propofol requirements decrease with adequate opioid analgesia 1
• Morphine premedication reduces necessary maintenance rates compared to non-narcotic premedication 1

Critical Safety Considerations

Cardiovascular monitoring:

• Propofol causes dose-dependent decreases in cardiac output, systemic vascular resistance, and arterial pressure 2, 3
• Continuous monitoring of heart rate, blood pressure, and oxygen saturation is mandatory 6
• Hypotension occurs in 5-7% of patients 6

Respiratory effects:

• Propofol causes dose-dependent respiratory depression 3
• Transient apnea episodes can occur, lasting 1-37 seconds 2
• Oxygen desaturation (SpO2 <90%) occurs in approximately 16% of cases 7

Propofol has no analgesic properties:

• Must be combined with opioids or other analgesics for painful procedures 3, 1
• Do not use as sole agent without adequate analgesia 6

Lipid content:

• Propofol provides 1.1 kcal/mL from lipid content 6
• Account for this when calculating nutritional requirements in ICU patients 6