Propofol

DIPRIVAN

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What it isGABA-A positive modulator; induction and maintenance of anesthesia and ICU sedation.

Why this oneRapid, clean offset from redistribution allows precise control and a fast wake-up.

What limits itDose-dependent hypotension and apnea; no analgesia at all. Propofol infusion syndrome with prolonged high-dose use.

FDA-approved for

induction/maintenance of anesthesia (1989)
ICU sedation (1989)

Off-label

refractory status epilepticus
sedation for severe ICU agitation

FDA label

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FDA dosing	Population	Start	Target	Max
Induction of general anesthesia	Adults <65y, ASA-PS I/II	2–2.5 mg/kg IV, titrated to response
Induction of general anesthesia	Elderly/debilitated/ASA-PS III/IV	1–1.5 mg/kg IV; no rapid bolus
Induction of general anesthesia	Pediatric 3–16y, ASA-PS I/II	2.5–3.5 mg/kg IV (younger children toward higher end; lower dose if ASA-PS III/IV)
Induction, neurosurgical	Adults	1–2 mg/kg IV (slow induction)
Induction, cardiac anesthesia	Adults	0.5–1.5 mg/kg IV (slow)
Maintenance of general anesthesia (infusion)	Adults	100–200 mcg/kg/min with 60–70% N2O/O2; 150–200 mcg/kg/min first 10–15 min, then decrease 30–50%	50–100 mcg/kg/min to optimize recovery
Maintenance of general anesthesia (intermittent bolus)	Adults	25–50 mg increments when vital signs indicate light anesthesia
Maintenance, cardiac anesthesia	Adults	25–100 mcg/kg/min, adjusted to sedation level/clinical response
Maintenance of general anesthesia	Pediatric ≥2 mo, ASA-PS I/II	Infusion 200–300 mcg/kg/min immediately after induction, then 125–150 mcg/kg/min after first half-hour; or bolus 1–4 mg/kg then 0.5–2 mg/kg increments
MAC sedation, initiation	Adults	Infusion 100–150 mcg/kg/min (6–9 mg/kg/hr) for 3–5 min, or slow injection ~0.5 mg/kg over 3–5 min
MAC sedation, maintenance	Adults	25–75 mcg/kg/min (1.5–4.5 mg/kg/hr) first 10–15 min, then decrease to 25–50 mcg/kg/min; or 10–20 mg intermittent boluses
MAC sedation	Elderly/debilitated/ASA-PS III/IV	~80% of usual adult dose; no rapid (single or repeated) bolus
ICU sedation (intubated, mechanically ventilated)	Adults	Initiate 5 mcg/kg/min (0.3 mg/kg/hr); increase by 5–10 mcg/kg/min q≥5min to desired sedation	maintenance usually 5–50 mcg/kg/min (0.3–3 mg/kg/hr); ≥50 mcg/kg/min may be needed in medical ICU patients	do not exceed 4 mg/kg/hr unless benefits outweigh risks

Titration Allow 3–5 min between dose adjustments to assess clinical effect (anesthesia/MAC); allow ≥5 min between ICU infusion-rate adjustments for onset of peak effect

Renal Undefined

Hepatic PK unchanged in chronic cirrhosis; long-term use in hepatic insufficiency and effects of acute hepatic failure not evaluated

Reduce induction dose and infusion rate in elderly/debilitated/ASA-PS III–IV; avoid rapid bolus to limit cardiorespiratory depression

Instructions

Shake well before use; inspect for phase separation/creaming
Administer only by persons trained in general anesthesia; monitor continuously (airway, ventilation, oxygen, resuscitation available)
Single-dose only; strict aseptic technique; complete administration within 12 hours of opening/spiking, then discard
Do not mix with other agents; if dilution needed use only 5% Dextrose to a concentration ≥2 mg/mL

Contraindications

History of anaphylaxis to eggs, egg products, soybeans, or soy products

Cautions

Fatal/life-threatening anaphylactic and anaphylactoid reactions
Microbial contamination risk — strict aseptic technique, single-patient use, 12-hour limit
Pediatric neurotoxicity with prolonged (>3 h) or repeated exposure in young children
Bradycardia, asystole, cardiac arrest (esp. pediatric patients with concomitant fentanyl)
Seizure risk during recovery in epileptic patients
Propofol Infusion Syndrome (metabolic acidosis, rhabdomyolysis, renal/cardiac failure) with high-dose (>5 mg/kg/h) prolonged (>48 h) infusion
Elevated serum triglycerides with prolonged infusion (lipid emulsion)
Benzyl alcohol 'gasping syndrome' in neonates/infants

Adverse reactions

Bradycardia
Arrhythmia
Tachycardia
Hypotension
Hypertension
Decreased cardiac output
Movement
Apnea
Respiratory acidosis during weaning
Rash
Pruritus
Injection-site burning/stinging/pain
Hyperlipemia

Pregnancy No drug-associated risk of birth defects/miscarriage identified; crosses placenta and may cause neonatal depression — monitor neonates for hypotonia and sedation.

Lactation Present in human milk; available data have not shown adverse reactions in breastfed infants.

NO BOXED WARNINGS

Principal riskHypotension and apnea; no analgesia at all