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Anaesthetic (IV Induction / Sedation) Pregnancy: B — used for induction at Caesarean section

Propofol

Brand names: Diprivan

Adult dose

Dose: Induction: 1.5–2.5mg/kg IV (titrate 40mg every 10 sec). TIVA maintenance: 4–12mg/kg/hr. ICU sedation: 0.3–4mg/kg/hr
Route: IV
Frequency: Continuous infusion or bolus
Elderly: reduce induction dose to 1–1.5mg/kg. Rate: use target-controlled infusion (TCI) when available. RSI: not ideal (slow onset vs thiopentone/ketamine).

Paediatric dose

Dose: 2.5 mg/kg
Route: IV
Frequency: Induction (single dose)
Induction: 2.5–3.5mg/kg in children 3–8 years (higher requirement). Not recommended for ICU sedation <16 years — propofol infusion syndrome risk.
Paediatric weight-based calculator

Induction: 2.5–3.5mg/kg in children 3–8 years (higher requirement). Not recommended for ICU sedation <16 years — propofol infusion syndrome risk.

Clinical pearls

  • PRIS risk: AVOID in children for ICU sedation. Adults: use <4mg/kg/hr for <48h — monitor CK, lactate, and triglycerides
  • Propofol infusion is milky white — visually distinct from other infusions (label clearly)
  • Antiemetic properties — preferred for day surgery and patients with PONV risk
  • Anticonvulsant properties — may be used for refractory status epilepticus
  • Contains 1.1 kcal/mL (fat emulsion) — account in nutritional calculations in ICU

Contraindications

  • Propofol infusion syndrome (PRIS) risk: children <16 in ICU — DO NOT USE for prolonged sedation
  • Egg or soy allergy (formulated in lipid emulsion)
  • Mitochondrial disease

Side effects

  • Pain on injection (pre-treat with IV lignocaine 40mg)
  • Hypotension
  • Apnoea
  • Bradycardia
  • Propofol Infusion Syndrome (PRIS): metabolic acidosis, rhabdomyolysis, cardiac failure — HIGH DOSE PROLONGED use

Interactions

  • Opioids, benzodiazepines — synergistic sedation/apnoea
  • Fentanyl — reduce propofol dose by 30%
  • Muscle relaxants — no direct interaction but hypotension after induction may compound

Monitoring

  • Blood pressure (continuous)
  • Respiratory rate and SpO2
  • CK, lactate, triglycerides (ICU > 48h or >4mg/kg/hr)
  • pH and bicarbonate (PRIS monitoring)

Reference: BNFc; AAGBI Propofol Guidance; ESICM Sedation Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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