What is the maintenance dose of propofol (sedative) in mL/hour?

Propofol Maintenance Dose in mL/hour

For ICU sedation, the typical maintenance infusion rate is 1.5-4.5 mL/hour (25-75 mcg/kg/min) for a 70 kg adult using standard 10 mg/mL propofol concentration, though rates must be adjusted based on patient age, condition, and clinical response. 1

Standard Maintenance Dosing by Clinical Context

ICU Sedation (Most Common Long-term Use)

• Standard adult maintenance: 25-75 mcg/kg/min (1.5-4.5 mg/kg/h) 1
• For a 70 kg patient with 10 mg/mL concentration: 1.5-4.5 mL/hour 1
• Mean infusion rate across clinical trials: 27 mcg/kg/min (approximately 1.6 mg/kg/h or 11 mL/hour for 70 kg patient) 1
• Elderly patients (>55 years): Require approximately 20 mcg/kg/min versus 38 mcg/kg/min in younger patients 1

General Anesthesia Maintenance

• Adult surgical patients: 50-100 mcg/kg/min (3-6 mg/kg/h) during maintenance phase 1
• For a 70 kg patient: 3-6 mL/hour 1
• Initial 10-15 minutes post-induction require higher rates of 150-200 mcg/kg/min, then decrease by 30-50% 1

MAC (Monitored Anesthesia Care) Sedation

• Maintenance range: 25-75 mcg/kg/min (1.5-4.5 mg/kg/h) 1
• For a 70 kg patient: 1.5-4.5 mL/hour 1
• After initial 10-15 minutes, decrease to 25-50 mcg/kg/min 1

Pediatric Maintenance (≥2 months old)

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

Critical Safety Thresholds

Maximum Safe Duration and Dosing

• Do not exceed 70 mcg/kg/min for >48 hours due to risk of Propofol Infusion Syndrome (PRIS), which carries 33% mortality 2
• PRIS characterized by metabolic acidosis, rhabdomyolysis, arrhythmias 2, 3
• Recent case reports document PRIS at rates as low as 1.9-2.6 mg/kg/h (32-43 mcg/kg/min) 3

Palliative/End-of-Life Sedation

• Loading dose: 20 mg 2
• Maintenance: 50-70 mg/hour (5-7 mL/hour with 10 mg/mL concentration) 2
• This represents approximately 12-17 mcg/kg/min for a 70 kg patient 2

Dose Adjustments for Special Populations

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

• Reduce maintenance dose to 80% of standard adult dosing 1
• Avoid rapid bolus administration due to increased risk of hypotension, apnea, and oxygen desaturation 1
• Higher peak plasma concentrations occur due to decreased volume of distribution 1

Cardiac Anesthesia Patients

• Minimum maintenance rate: 50-100 mcg/kg/min when propofol is primary agent 1
• When opioid is primary agent: minimum 50 mcg/kg/min 1
• Avoid high-dose opioid technique with propofol due to increased hypotension risk 1

Combination with Opioids

• When combined with fentanyl or other opioids, propofol requirements decrease significantly 4, 5
• Recommended propofol infusion: 25-50 mcg/kg/min with alfentanil 0.2-0.4 mcg/kg/min for MAC sedation 5
• Combination increases respiratory depression risk; 5-7% experience transient desaturation <90% 4

Practical Conversion for mL/hour Calculation

Formula: (mcg/kg/min × weight in kg × 60 min) ÷ (concentration in mcg/mL)

For 10 mg/mL (10,000 mcg/mL) propofol in a 70 kg patient:

• 25 mcg/kg/min = 1.05 mL/hour
• 50 mcg/kg/min = 2.1 mL/hour
• 75 mcg/kg/min = 3.15 mL/hour
• 100 mcg/kg/min = 4.2 mL/hour

Common Pitfalls to Avoid

• Failure to reduce infusion rate over time: Propofol clearance is 23-50 mL/kg/min, but prolonged infusion leads to accumulation requiring rate reduction 1
• Not accounting for lipid calories: Propofol provides 1.1 kcal/mL from lipid content, which must be included in nutritional calculations for ICU patients 2
• Inadequate analgesia: Propofol has no analgesic properties; must combine with opioids for painful procedures 2, 4
• CYP2B6 poor metabolizers: Reduce maintenance to 25 mcg/kg/min (approximately 50% reduction) 2
• Oversedation in elderly: Age-related pharmacokinetic changes require 20% lower doses 1