What is the recommended dose of Propofol (propofol) for procedural sedation?

From the Guidelines

For procedural sedation, propofol is typically administered as an initial bolus of 1 mg/kg IV, followed by additional boluses of 0.5 mg/kg, as this dosing regimen has been shown to be safe and effective in pediatric patients 1.

Key Considerations

• The dose of propofol should be titrated to the desired level of sedation, with careful monitoring of vital signs, including oxygen saturation, blood pressure, and cardiac rhythm.
• Airway equipment should be immediately available as propofol can cause respiratory depression and loss of protective airway reflexes.
• The medication should be administered by clinicians trained in airway management, and the patient should be kept NPO (typically 6 hours for solids, 2 hours for clear liquids) prior to elective procedures.

Evidence-Based Recommendations

• A study by Guenther et al 1 found that a protocol delivering propofol with fentanyl as 1–2 mg/kg, followed by subsequent doses of 0.5 mg/kg, was safe and effective for administration by pediatric emergency physicians in an ED-associated sedation unit.
• Another study by Havel et al 1 found that propofol was effective and safe for painful procedures in the ED, with a bolus dose of 1 mg/kg and an infusion rate of 4–6 mg/kg/h.

Important Safety Considerations

• Propofol can cause respiratory depression and loss of protective airway reflexes, so airway equipment should be immediately available.
• The medication should be administered by clinicians trained in airway management.
• Continuous monitoring of vital signs is essential during propofol administration.

Conclusion Not Applicable - Answer Only

Propofol is a safe and effective medication for procedural sedation when used at the recommended dose and with proper monitoring and airway management 1.

From the FDA Drug Label

When propofol injectable emulsion is administered for MAC sedation, rates of administration should be individualized and titrated to clinical response In most patients, the rates of propofol injectable emulsion administration will be in the range of 25 mcg/kg/min to 75 mcg/kg/min. For initiation of MAC sedation, either an infusion or a slow injection method may be utilized while closely monitoring cardiorespiratory function With the infusion method, sedation may be initiated by infusing propofol injectable emulsion at 100 mcg/kg/min to 150 mcg/kg/min (6 mg/kg/h to 9 mg/kg/h) for a period of 3 minutes to 5 minutes and titrating to the desired clinical effect while closely monitoring respiratory function. Maintenance of MAC Sedation For maintenance of sedation, a variable rate infusion method is preferable over an intermittent bolus dose method. With the variable rate infusion method, patients will generally require maintenance rates of 25 mcg/kg/min to 75 mcg/kg/min (1.5 mg/kg/h to 4.5 mg/kg/h) during the first 10 minutes to 15 minutes of sedation maintenance.

The recommended dose of propofol for procedural sedation is in the range of 25 mcg/kg/min to 75 mcg/kg/min.

• Initiation of sedation: Infuse at 100 mcg/kg/min to 150 mcg/kg/min for 3 to 5 minutes.
• Maintenance of sedation: Use a variable rate infusion method with rates of 25 mcg/kg/min to 75 mcg/kg/min. 2

From the Research

Propofol Dose for Procedural Sedation

• The optimal dose of propofol for procedural sedation varies depending on the patient and procedure characteristics, as well as personal or local preferences 3, 4, 5, 6.
• A study published in 2017 found that a median dose of 75mg of propofol was effective for procedural sedation in the emergency department, with a higher procedure success rate and shorter sedation duration compared to midazolam 3.
• Another study published in 2007 used a standardized protocol with an initial dose of 0.25-0.5 mg/kg of propofol, followed by 10-20 mg/minute until sedated, and found a mean total propofol dose of 1.6 mg/kg was required for procedural sedation and analgesia in the emergency department 4.
• A retrospective review of procedural sedations performed with propofol in an emergency department from 2005 to 2010 found that the mean patient age was 29 years and the frequency of adverse events was not statistically different from the published rate for all moderate and deep sedatives 5.
• A randomized single-blinded control trial published in 2011 compared the use of propofol and midazolam for procedural sedation and analgesia in the emergency department, and found that both drugs were equally safe and effective, but the propofol group was discharged much earlier than the midazolam group 6.
• A scoping review published in 2021 found that patient-maintained propofol sedation is a promising technique, but high-quality experimental clinical trials are urgently required to assess its safety and comparative clinical effectiveness 7.

Adverse Events

• Transient apnea was the most prevalent adverse event associated with propofol sedation, followed by oxygen desaturation, airway obstruction, and hypotension 3, 4, 5.
• Hypotension was the most common adverse event, occurring in 2.33% of patients, followed by brief hypoxia and brief apnea 5.
• No patient required advanced airway management, and all patients recovered completely from the procedural sedation and were discharged from the emergency department in stable and improved condition 5.

Patient Satisfaction

• Patients who received propofol for procedural sedation and analgesia reported high satisfaction rates, with 92% of patients very satisfied and 8% satisfied 4.
• Physicians also reported high satisfaction rates, with 85% of physicians very satisfied and 6% satisfied with the sedation and conditions achieved 4.