Usual Adult Dose for Anesthesia

NOTE: The dosages presented are manufacturer suggested doses. Actual doses used vary widely between patients. Local protocol should be consulted before administering this drug.

INDUCTION OF GENERAL ANESTHESIA:

• Adults less than 55 years of age and classified as ASA-PS I or II: 2 to 2.5 mg/kg IV titrated at approximately 40 mg every 10 seconds until onset of induction; the amount of IV opioid and/or benzodiazepine premedication will influence the response of the patient to an induction dose
• Cardiac Anesthesia: 20 mg every 10 seconds until induction onset (0.5 to 1.5 mg/kg)
• Neurosurgical Patients: 20 mg (1 to 2 mg/kg) IV every 10 seconds until induction onset

• Adults less than 55 years of age and classified as ASA-PS I OR II: 100 to 200 mcg/kg/minute (6 to 12 mg/kg/h) IV as a variable rate infusion with 60% to 70% nitrous oxide and oxygen provides anesthesia for patients undergoing general surgery.
• Maintenance immediately following the induction dose: During the initial period following the induction dose, higher rates of infusion are generally required (150 to 200 mcg/kg/min IV) for the first 10 to 15 minutes; then decreased 30% to 50% during the first half-hour of maintenance; 50 to 100 mcg/kg/min in adults should be achieved during maintenance to optimize recovery times.
• Neurosurgical Patients: 100 to 200 mcg/kg/min (6 mg/kg/h to 12 mg/kg/h) IV

• Adults less than 55 years of age and classified as ASA-PS I OR II: Increments of 25 to 50 mg may be administered with nitrous oxide in adult patients undergoing general surgery.

• Adults less than 55 years of age and classified as ASA-PS I OR II: Slow infusion/injection is recommended to avoid apnea or hypotension. Most patients require 100 to 150 mcg/kg/min (6 to 9 mg/kg/h) for 3 to 5 minutes or a slow injection of 0.5 mg/kg over 3 to 5 minutes followed immediately by a maintenance infusion.

• Infusion method: 100 to 150 mcg/kg/min (6 mg/kg/h to 9 mg/kg/h) over 3 to 5 minutes and titrate to the desired clinical effect while monitoring respiratory function.
• Slow injection method: 0.5 over 3 to 5 minutes and titrated to clinical responses; when administered slowly over 3 minutes to 5 minutes, most patients will be adequately sedated, and the peak drug effect can be achieved while minimizing undesirable cardiorespiratory effects occurring at high plasma levels.

• Infusion rates should always be titrated downward in the absence of signs of light sedation until mild responses to stimulation are obtained.
• With the intermittent bolus method, there is increased potential for respiratory depression, transient increases in sedation depth, and prolongation of recovery.

• Most adult ICU patients recovering from the effects of general anesthesia or deep sedation: Because of the residual effects of previous anesthetic or sedative agents, in most patients the initial infusion should be 5 mcg/mg/kg (0.3 to 0.6 mg/kg/h for at least 5 minutes; subsequent increments of 5 to 10 mcg/kg/min (0.3 to 0.6 mg/kg/h) over 5 to 10 minutes may be used until desired effect is achieved; maintenance rates of 5 to 50 mcg/kg/min (0.3 to 3 mg/kg/h) or higher may be required; do not exceed 4 mg/kg/hour unless the benefits outweigh the risks.

• Dosage and rate of administration should be individualized and titrated to the desired effect, according to factors including the patient underlying medical problems, preinduction and concomitant medications, age, ASA-PS classification, and level of debilitation of the patient. The elderly, debilitated, and ASA-PS III or IV patients may have exaggerated hemodynamic and respiratory responses to rapid bolus doses (see (for at least 5 minutes; subsequent increments of 5 to 10 mcg/kg/min (0.3 to 0.6 mg/kg/hr) over 5 to 10 minutes may be used until the desired clinical effect is achieved; maintenance rates of 5 to 50 mcg/kg/min IV (0.3 to 3 mg/kg/hr) or higher may be required; administration should not exceed 4 mg/kg/hr IV unless the benefits outweigh the risks

• Preinduction anxiolysis: 25 mcg/kg/min IV
• Induction: 0.5 to 1.5 mg/kg IV over 60 seconds
• Maintenance (Titrated to Clinical Response): 100 mcg/kg/min to 150 mcg/kg/min IV
• Secondary fentanyl equivalents: 0.05 to 0.075 mcg/kg/min (no bolus)

• Induction: 50 to 100 mcg/kg/min IV
• Maintenance: 0.2 to 0.3 mcg/kg/min IV
• Secondary propofol: 50 to 100 mcg/kg/min (no bolus)

• Avoid rapid bolus injections.
• A slow rate of about 20 mg every 10 seconds IV until induction onset (0.5 mg/kg to 1.5 mg/kg) should be used.
• To assure adequate anesthesia, when propofol is the only agent used, ed as the primary agent, maintenance infusion rates should not be less than 100 mcg/kg/min and should be supplemented with analgesic levels of continuous opioid administration.
• When an opioid is used as the primary agent, propofol maintenance rates should not be less than 50 mcg/kg/min, and care should be taken to ensure amnesia. -Higher doses of propofol will reduce opioid requirements.
• When propofol is used as the primary anesthetic, it should not be administered with the high-dose opioid technique as this may increase the likelihood of hypotension.

• Induction of general anesthesia
• Maintenance of general anesthesia
• Initiation and maintenance of monitored anesthesia care (MAC) sedation
• Intensive care unit (ICU) sedation of intubated, mechanically ventilated patients

Usual Geriatric Dose for Anesthesia

NOTE: The dosages presented are manufacturer suggested doses. Actual doses used vary widely between patients. Local protocol should be consulted before administering this drug.

INDUCTION OF GENERAL ANESTHESIA:

• Elderly, debilitated, or ASA III/IV patients: 20 mg every 10 seconds (1 to 1.5 mg/kg) IV until onset of induction; rapid boluses should not be used, as this will increase the likelihood of undesirable cardiorespiratory depression including hypotension, apnea, airway obstruction, and/or oxygen desaturation

• Elderly, debilitated, or ASA III/IV patients: 50 to 100 mcg/kg/min IV (3 to 6 mg/kg/hr); avoid rapid boluses

• Elderly, debilitated, or ASA III/IV patients: Most patients require 80% to 100% of the usual adult dose; a rapid (single or repeated) bolus dose should not be used.

• Elderly, debilitated, or ASA III/IV patients: Most patients require 80% of the usual adult dose; a rapid (single or repeated) bolus dose should not be used.

• Most adult ICU patients recovering from the effects of general anesthesia or deep sedation: Because of the residual effects of previous anesthetic or sedative agents, in most patients the initial infusion should be 5 mcg/mg/kg (0.3 to 0.6 mg/kg/h for at least 5 minutes; subsequent increments of 5 to 10 mcg/kg/min (0.3 to 0.6 mg/kg/h) over 5 to 10 minutes may be used until desired effect is achieved; maintenance rates of 5 to 50 mcg/kg/min (0.3 to 3 mg/kg/h) or higher may be required; do not exceed 4 mg/kg/hour unless the benefits outweigh the risks.

• Dosage and rate of administration should be individualized and titrated to the desired effect, according to factors including the patient underlying medical problems, preinduction and concomitant medications, age, ASA-PS classification, and level of debilitation of the patient. The elderly, debilitated, and ASA-PS III or IV patients may have exaggerated hemodynamic and respiratory responses to rapid bolus doses (see (for at least 5 minutes; subsequent increments of 5 to 10 mcg/kg/min (0.3 to 0.6 mg/kg/hr) over 5 to 10 minutes may be used until the desired clinical effect is achieved; maintenance rates of 5 to 50 mcg/kg/min IV (0.3 to 3 mg/kg/hr) or higher may be required; administration should not exceed 4 mg/kg/hr IV unless the benefits outweigh the risks

• Preinduction anxiolysis: 25 mcg/kg/min IV
• Induction: 0.5 to 1.5 mg/kg IV over 60 seconds
• Maintenance (Titrated to Clinical Response): 100 mcg/kg/min to 150 mcg/kg/min IV
• Secondary fentanyl equivalents: 0.05 to 0.075 mcg/kg/min (no bolus)

• Induction: 50 to 100 mcg/kg/min IV
• Maintenance: 0.2 to 0.3 mcg/kg/min IV
• Secondary propofol: 50 to 100 mcg/kg/min (no bolus)

• Avoid rapid bolus injections.
• A slow rate of about 20 mg every 10 seconds IV until induction onset (0.5 mg/kg to 1.5 mg/kg) should be used.
• To assure adequate anesthesia, when propofol is the only agent used, ed as the primary agent, maintenance infusion rates should not be less than 100 mcg/kg/min and should be supplemented with analgesic levels of continuous opioid administration.
• When an opioid is used as the primary agent, propofol maintenance rates should not be less than 50 mcg/kg/min, and care should be taken to ensure amnesia.
• Higher doses of propofol will reduce opioid requirements.
• When propofol is used as the primary anesthetic, it should not be administered with the high-dose opioid technique as this may increase the likelihood of hypotension.

• Induction of general anesthesia
• Maintenance of general anesthesia
• Initiation and maintenance of monitored anesthesia care (MAC) sedation
• Intensive care unit (ICU) sedation of intubated, mechanically ventilated patients

• Elderly, debilitated, or ASA III/IV patients: 20 mg every 10 seconds (1 to 1.5 mg/kg) IV until onset of induction; rapid boluses should not be used, as this will increase the likelihood of undesirable cardiorespiratory depression including hypotension, apnea, airway obstruction, and/or oxygen desaturation

• Elderly, debilitated, or ASA III/IV patients: 50 to 100 mcg/kg/min IV (3 to 6 mg/kg/hr); avoid rapid boluses

• Elderly, debilitated, or ASA III/IV patients: Most patients require 80% to 100% of the usual adult dose; a rapid (single or repeated) bolus dose should not be used.

• Elderly, debilitated, or ASA III/IV patients: Most patients require 80% of the usual adult dose; a rapid (single or repeated) bolus dose should not be used.

• Most adult ICU patients recovering from the effects of general anesthesia or deep sedation: Because of the residual effects of previous anesthetic or sedative agents, in most patients the initial infusion should be 5 mcg/mg/kg (0.3 to 0.6 mg/kg/h for at least 5 minutes; subsequent increments of 5 to 10 mcg/kg/min (0.3 to 0.6 mg/kg/h) over 5 to 10 minutes may be used until desired effect is achieved; maintenance rates of 5 to 50 mcg/kg/min (0.3 to 3 mg/kg/h) or higher may be required; do not exceed 4 mg/kg/hour unless the benefits outweigh the risks.

• Dosage and rate of administration should be individualized and titrated to the desired effect, according to factors including the patient underlying medical problems, preinduction and concomitant medications, age, ASA-PS classification, and level of debilitation of the patient. The elderly, debilitated, and ASA-PS III or IV patients may have exaggerated hemodynamic and respiratory responses to rapid bolus doses (see (for at least 5 minutes; subsequent increments of 5 to 10 mcg/kg/min (0.3 to 0.6 mg/kg/hr) over 5 to 10 minutes may be used until the desired clinical effect is achieved; maintenance rates of 5 to 50 mcg/kg/min IV (0.3 to 3 mg/kg/hr) or higher may be required; administration should not exceed 4 mg/kg/hr IV unless the benefits outweigh the risks

• Preinduction anxiolysis: 25 mcg/kg/min IV
• Induction: 0.5 to 1.5 mg/kg IV over 60 seconds
• Maintenance (Titrated to Clinical Response): 100 mcg/kg/min to 150 mcg/kg/min IV
• Secondary fentanyl equivalents: 0.05 to 0.075 mcg/kg/min (no bolus)

• Induction: 50 to 100 mcg/kg/min IV
• Maintenance: 0.2 to 0.3 mcg/kg/min IV
• Secondary propofol: 50 to 100 mcg/kg/min (no bolus)

• Avoid rapid bolus injections.
• A slow rate of about 20 mg every 10 seconds IV until induction onset (0.5 mg/kg to 1.5 mg/kg) should be used.
• To assure adequate anesthesia, when propofol is the only agent used, ed as the primary agent, maintenance infusion rates should not be less than 100 mcg/kg/min and should be supplemented with analgesic levels of continuous opioid administration.
• When an opioid is used as the primary agent, propofol maintenance rates should not be less than 50 mcg/kg/min, and care should be taken to ensure amnesia.
• Higher doses of propofol will reduce opioid requirements.
• When propofol is used as the primary anesthetic, it should not be administered with the high-dose opioid technique as this may increase the likelihood of hypotension.

• Induction of general anesthesia
• Maintenance of general anesthesia
• Initiation and maintenance of monitored anesthesia care (MAC) sedation
• Intensive care unit (ICU) sedation of intubated, mechanically ventilated patients

Usual Pediatric Dose for Anesthesia

NOTE: The dosages presented are manufacturer suggested doses. Actual doses used vary widely between patients. Local protocol should be consulted before administering this drug.

INDUCTION OF GENERAL ANESTHESIA:

• Age 3 years to 16 years and classified ASA-PS I or II: 2.5 to 3.5 mg/kg IV over 20 to 30 seconds when unpremedicated or when lightly premedicated with oral benzodiazepines or IM opioids. Within this dose range, younger patients may require higher induction doses than older pediatric patients. A lower dose is recommended for pediatric patients classified as ASA-PS III or IV.

• Age 2 months to 16 years and classified ASA-PS I or II healthy: 200 to 300 mcg/kg/min should immediately follow the induction dose; following the first half-hour of maintenance, infusion rates of 125 to 150 mcg/kg/min are needed; titrate to desired effect; following the first half hour of maintenance, if signs of light anesthesia are not present, the infusion rate should be decreased.

• Younger pediatric patients may require higher maintenance infusion rates than older patients.
• Attention should be paid to minimize pain on injection when administering this drug to pediatric patients. Boluses may be administered via small veins if pretreated with lidocaine or via antecubital or larger veins.

• Induction of general anesthesia in pediatric patients 3 to 16 years of age
• Maintenance of general anesthesia in pediatric patients age 2 months to 16 years

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

CONTRAINDICATIONS:

• Hypersensitivity to the active component or any of the ingredients
• In patients with allergies to eggs, egg products, soybeans, or soy products

• Safety and efficacy have not been established in patients younger than 2 months for maintenance of general anesthesia.
• Safety and efficacy have not been established in patients younger than 16 years for initiation and maintenance of monitored anesthesia care (MAC) sedation.
• Safety and efficacy have not been established in patients younger than 16 years for intensive care unit (ICU) sedation of intubated, mechanically ventilated patients.

Dialysis

Data not available

Other Comments

General:

• This drug should be administered only by persons trained in the administration of general anesthesia and not involved in the Procedure.
• Facilities for maintenance of an airway, providing artificial ventilation, administering supplemental oxygen, and instituting cardiovascular resuscitation should be immediately available.
• The safety of this drug has not been established when used for continuous infusion.
• This drug contains benzyl alcohol.
• The tubing and any unused portions of drug should be discarded after 12 hours because the vial contains no preservatives and is capable of supporting growth of microorganisms.

• Patients should be monitored for their ability to demonstrate purposeful response while sedated.
• Patients should be monitored during sedation and through the recovery process for early signs of hypotension, apnea, airway obstruction, and/or oxygen desaturation.
• Caution is recommended in patients with cardiac, respiratory, renal or hepatic dysfunction, and patients who are hypovolemic or debilitated.
• This drug should be used cautiously in patients with lipid metabolism disorders.
• This drug has been associated with reports of bradycardia (possibly profound) and asystole. The IV administration of an anticholinergic agent prior to induction, or during maintenance of anesthesia should be considered, especially in situations where vagal tone is likely to predominate or when this drug is used in conjunction with other agents likely to cause bradycardia.
• This drug reduces cerebral blood flow, intracranial pressure, and cerebral metabolism. This reduction in intracranial pressure is greater in patients with an elevated baseline intracranial pressure.
• There is a risk of seizure during the recovery phase following administration of this drug to a patient with epilepsy.
• There are very rare reports of metabolic acidosis, rhabdomyolysis, hyperkalemia, and/or rapidly progressive cardiac failure (occasionally fatal) in adults treated with an infusion in excess of 5 mg/kg/hour for more than a 58-hour duration. The majority of these reports, though not all, have been in patients with serious head injuries associated with intracranial pressure. Decreasing the dosage or switching to an alternative sedative should be considered if these adverse effects continue. -The maximum dosage of propofol for adult sedation in an intensive care setting should not exceed 4 mg/kg/hour.
• This drug is not recommended by the manufacturer for obstetrics, including Cesarean section deliveries as it crosses the placenta, and may be associated with neonatal depression.

• Patients undergoing anesthesia or sedation (particularly those undergoing outpatient surgery or procedures) should be warned of the potential for central nervous system depression. Driving, or other hazardous activities should be avoided.