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Intravenous Anaesthetic Agent Pregnancy: UK SPC §4.6, verbatim: 'The safety of propofol during pregnancy has not been established. Studies in animals have shown reproductive toxicity (see section 5.3). Propofol should not be given to pregnant women except when absolutely necessary. Propofol crosses the placenta and can cause neonatal depression. Propofol can, however, be used during an induced abortion.' Breast-feeding: 'Studies of breast-feeding mothers showed that small quantities of propofol are excreted in human milk. Women should therefore not breastfeed for 24 hours after administration of propofol. Milk produced during this period should be discarded.' Fertility: 'No data available.' The US §8.1 risk summary reaches a softer conclusion — decades of trial, cohort and case-series data 'have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes', with reports of neonatal depression after exposure at delivery.

Propofol (TCI / TIVA)

Brand names: Diprivan, Propofol 1%, Propofol 2%

Propofol delivered by target-controlled infusion (TCI) is the cornerstone of total intravenous anaesthesia (TIVA), providing titratable induction and maintenance of general anaesthesia and sedation.

Adult dose

Dose: General anaesthesia — induction: 1.5 to 2.5 mg/kg body weight in adults younger than 55 years, titrated 20-40 mg every 10 seconds against the patient's response until clinical signs show the onset of anaesthesia. Maintenance by continuous infusion (TIVA): 4-12 mg/kg body weight/hour, titrated to the depth of anaesthesia required.
Route: Intravenous — 'Propofol is given intravenously', undiluted by injection or by continuous infusion, undiluted or diluted with glucose 5%, sodium chloride 0.9%, or sodium chloride 0.18% with glucose 4%. All millilitre volumes quoted here are for the 1% (10 mg/ml) product this SPC covers; no 2% label is in this bundle, so no 2% volume is asserted. Use burettes, drop counters, syringe pumps or volumetric infusion pumps to control the rate; filters must be lipid-permeable.
Frequency: Titrated induction bolus, then continuous infusion titrated to depth of anaesthesia. Maintenance may instead be given by repeat bolus increments of 25 mg (2.5 ml of 1%) to 50 mg (5.0 ml of 1%) 'according to clinical requirements'.
Max: No maximum dose is stated anywhere in the SPC — every regimen is titrated to the patient's response. The 'maximum' statements the SPC does make are limits on duration and dilution, not dose ceilings; they are quoted in the notes.
SCOPE — THIS PAGE IS TITLED 'TCI / TIVA' AND THE SPC GIVES NO TCI TARGET CONCENTRATIONS. What is published above is the page's primary content: weight-based intravenous induction and infusion maintenance of general anaesthesia (TIVA). §4.2 verbatim on TCI: 'Propofol may also be used by Target Controlled Infusion. Due to the different algorithms available on the market for dosage recommendations please refer to the instructions for use leaflet of the device manufacturer.' A reader looking for a Marsh or Schnider target in micrograms/ml will not find one here, and the mg/kg figures above must not be read as targets. §4.2 also states: 'Administration of propofol by Target Controlled Infusion (TCI) system is not advised for sedation in the intensive care unit.' || WHO MAY GIVE IT, §4.2 verbatim: 'Propofol must only be given in hospitals or adequately equipped day therapy units by physicians trained in anaesthesia or in the care of patients in intensive care.' 'For sedation during surgical or diagnostic procedures Propofol should not be given by the same person that carries out the surgical or diagnostic procedure.' 'Supplementary analgesic medicinal products are generally required in addition to Propofol.' || OLDER AND ASA III-IV PATIENTS: for induction, 'In patients over this age and in patients of ASA grades III and IV, especially those with impaired cardiac function, the dosage requirements will be less and the total dose... may be reduced to a minimum of 1 mg/kg body weight. In these patients lower rates of administration should be applied (approximately 2 ml, corresponding to 20 mg every 10 seconds).' For maintenance, 'In elderly patients, in patients of poor general condition, in patients of ASA grades III and IV, in hypovolaemic patients and patients with hypoproteinemia the dosage may have to be reduced further.' 'Rapid bolus administration (single or repeated) should not be used in older people as this may lead to cardiorespiratory depression.' US §8.5 agrees: average induction dose 1.99 mg/kg up to 54 years versus 1.66 mg/kg above 54, and 'A lower induction dose and a slower maintenance rate of administration of propofol injectable emulsion should be used in elderly patients.' || OTHER REGIMENS IN THE SAME SPC, recorded for completeness — these are NOT the page's primary indication and are labelled with their own: SEDATION OF VENTILATED PATIENTS IN INTENSIVE CARE — continuous infusion, rate determined by the desired depth of sedation, 'In most patients sufficient sedation can be obtained with a dosage of 0.3-4 mg/kg/h'; 'Propofol is not indicated for sedation in intensive care of patients of 16 years of age or younger.' SEDATION FOR DIAGNOSTIC AND SURGICAL PROCEDURES IN ADULTS — 'Most patients will require 0.5-1 mg/kg body weight over 1 to 5 minutes for onset of sedation'; maintenance 'Most patients will require 1.5-4.5 mg/kg body weight/h'; supplementary bolus 10-20 mg (1-2 ml of 1%) 'if a rapid increase of the depth of sedation is required'. || DURATION AND HANDLING LIMITS (§4.2, verbatim): 'Propofol can be administered for a maximum period of 7 days.' 'The duration of continuous infusion of Propofol from one infusion system must not exceed 12 hours' — discard and replace the line and reservoir at that point. Diluted propofol: 'The maximum dilution must not exceed 1 part of Propofol with 4 parts of' diluent (minimum concentration 2 mg propofol/ml), prepared aseptically immediately before use and used within 6 hours. Propofol 'contains no antimicrobial preservatives and supports growth of microorganisms' — draw up aseptically and start administration without delay; single use in one patient. || PAIN ON INJECTION: 'In order to reduce pain on initial injection, Propofol may be mixed with preservative-free lidocaine injection 1% (mix 20 parts of Propofol with up to 1 part of lidocaine injection 1%).' US §2.1 caps this at 'quantities not exceeding 20 mg lidocaine/200 mg propofol'. Rinse the line before giving atracurium or mivacurium through it. || PROPOFOL INFUSION SYNDROME IS NOT DESCRIBED IN THIS BUNDLE. What the bundle does contain is the §4.8 'frequency not known' cluster PRIS is made of — metabolic acidosis, hyperkalaemia, hyperlipidaemia, rhabdomyolysis, cardiac arrhythmia, cardiac failure, renal failure, hepatomegaly and Brugada-type ECG — with its explanatory footnotes also truncated. Re-fetch the full §4.4 before publishing any PRIS threshold.

Paediatric dose

Dose: 2.5 mg/kg
Route: Intravenous
Frequency: Single induction dose, slowly titrated against response; maintenance of anaesthesia by infusion or repeated bolus, with infusion rates 'in the region of 9-15 mg/kg/h'
Max: No maximum dose is stated in §4.2; lower doses are recommended for ASA grade III and IV patients.
Concentration: 10 mg/ml
SPC §4.2, 'General anaesthesia in children over 1 month of age', verbatim: 'For induction of anaesthesia Propofol should be slowly titrated against the patient's response until the clinical signs show the onset of anaesthesia. The dosage should be adjusted according to age and/or body weight. Most patients over 8 years of age require approximately 2.5 mg/kg body weight of propofol for induction of anaesthesia. In younger children, especially between the age of 1 month and 3 years, dose requirements may be higher (2.5-4 mg/kg body weight).' The 2.5 mg/kg published here is the figure stated for patients over 8 years and the bottom of the range stated for 1 month to 3 years; it is a starting point for titration, not a fixed dose, and children aged 1 month to 3 years may need up to 4 mg/kg. || MAINTENANCE: 'rates in the region of 9-15 mg/kg/h usually achieve satisfactory anaesthesia. In younger children, especially between the age of 1 month and 3 years, dose requirements may be higher. For ASA III and IV patients lower doses are recommended.' || SEDATION for diagnostic and surgical procedures in children over 1 month (a different indication): 'Most paediatric patients require 1-2 mg/kg body weight of propofol for onset of sedation', maintenance 'Most patients require 1.5-9 mg/kg/h', supplemented if needed by a bolus of up to 1 mg/kg. || CONTRAINDICATED for intensive care sedation in patients aged 16 years or younger (§4.3). US §8.4: effectiveness is established for induction from 3 years of age and for maintenance from 2 months, propofol is not indicated in children for ICU or MAC sedation, and 'In pediatric patients, administration of fentanyl concomitantly with propofol injectable emulsion may result in serious bradycardia.' || Concentration 10 mg/ml is the strength of the product this SPC covers, 'Propofol 1% (10 mg/ml)'; US §3 lists the same 10 mg per mL strength. A 2% (20 mg/ml) product exists commercially but no 2% label is in this bundle — check the vial before calculating a volume. || Verify every under-18 dose against a children's formulary before use.

Dose adjustments

Renal

No numeric dose adjustment is given. UK SPC §4.4, verbatim: 'As with other intravenous anaesthetic agents, caution should be applied in patients with cardiac, respiratory, renal or hepatic impairment or in hypovolaemic or debilitated patients (see also section 4.2).' §4.2 adds that in patients of poor general condition, ASA grades III-IV, hypovolaemia and hypoproteinaemia the maintenance dosage 'may have to be reduced further'. (§4.4 is truncated at the fetch limit, so a fuller statement may exist in the complete SPC.)

Hepatic

No numeric dose adjustment is given — the same §4.4 sentence covers hepatic impairment: 'caution should be applied in patients with cardiac, respiratory, renal or hepatic impairment or in hypovolaemic or debilitated patients'. §4.4 also notes: 'Propofol clearance is blood flow dependent, therefore, concomitant medication that reduces cardiac output will also reduce propofol clearance.' Some sections of the product information we used were incomplete — check the full SPC.

Dose independently re-sourced from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — clinician-reviewed. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

SPC §4.2, 'General anaesthesia in children over 1 month of age', verbatim: 'For induction of anaesthesia Propofol should be slowly titrated against the patient's response until the clinical signs show the onset of anaesthesia. The dosage should be adjusted according to age and/or body weight. Most patients over 8 years of age require approximately 2.5 mg/kg body weight of propofol for induction of anaesthesia. In younger children, especially between the age of 1 month and 3 years, dose requirements may be higher (2.5-4 mg/kg body weight).' The 2.5 mg/kg published here is the figure stated for patients over 8 years and the bottom of the range stated for 1 month to 3 years; it is a starting point for titration, not a fixed dose, and children aged 1 month to 3 years may need up to 4 mg/kg. || MAINTENANCE: 'rates in the region of 9-15 mg/kg/h usually achieve satisfactory anaesthesia. In younger children, especially between the age of 1 month and 3 years, dose requirements may be higher. For ASA III and IV patients lower doses are recommended.' || SEDATION for diagnostic and surgical procedures in children over 1 month (a different indication): 'Most paediatric patients require 1-2 mg/kg body weight of propofol for onset of sedation', maintenance 'Most patients require 1.5-9 mg/kg/h', supplemented if needed by a bolus of up to 1 mg/kg. || CONTRAINDICATED for intensive care sedation in patients aged 16 years or younger (§4.3). US §8.4: effectiveness is established for induction from 3 years of age and for maintenance from 2 months, propofol is not indicated in children for ICU or MAC sedation, and 'In pediatric patients, administration of fentanyl concomitantly with propofol injectable emulsion may result in serious bradycardia.' || Concentration 10 mg/ml is the strength of the product this SPC covers, 'Propofol 1% (10 mg/ml)'; US §3 lists the same 10 mg per mL strength. A 2% (20 mg/ml) product exists commercially but no 2% label is in this bundle — check the vial before calculating a volume. || Verify every under-18 dose against a children's formulary before use.

Verify in a children's formulary

Contraindications

  • Hypersensitivity to the active substance, soya, peanut or to any of the excipients listed in section 6.1 (UK SPC §4.3). The US label gives 'a history of anaphylaxis to eggs, egg products, soybeans or soy products'
  • Sedation for intensive care in patients of 16 years of age or younger — UK SPC §4.3, verbatim: 'Propofol must not be used in patients of 16 years of age or younger for sedation for intensive care. Safety and efficacy for these age groups have not been demonstrated'
  • Not a contraindication but a restriction on the setting (§4.2/§4.4): propofol must only be given in hospitals or adequately equipped day therapy units, by physicians trained in anaesthesia or intensive care, with airway, ventilation and resuscitation facilities immediately available, and not by the person performing the procedure
  • Not a contraindication but a method limit (§4.2): 'Administration of propofol by Target Controlled Infusion (TCI) system is not advised for sedation in the intensive care unit'

Side effects

  • Very common (≥1/10): local pain on induction (UK SPC §4.8)
  • Common (≥1/100 to <1/10): hypotension; bradycardia; transient apnoea during induction; nausea and vomiting during the recovery phase; headache during the recovery phase (UK SPC §4.8). §4.4: propofol 'lacks vagolytic activity and has been associated with reports of bradycardia (occasionally profound) and also asystole' — consider an intravenous anticholinergic before induction or during maintenance where vagal tone is likely to predominate
  • Uncommon (≥1/1000 to <1/100): injection site thrombosis and injection site phlebitis (UK SPC §4.8)
  • Rare (≥1/10 000 to <1/1000): epileptiform movements, including convulsions and opisthotonus, during induction, maintenance and recovery (UK SPC §4.8). §4.4: 'When propofol is administered to an epileptic patient, there may be a risk of convulsion'
  • Very rare (<1/10 000): anaphylaxis up to anaphylactic shock — may include angioedema, bronchospasm, erythema and hypotension; postoperative unconsciousness; pulmonary oedema; pancreatitis; sexual disinhibition; discolouration of urine following prolonged administration; tissue necrosis following accidental extravascular administration; postoperative fever (UK SPC §4.8)
  • Frequency not known: metabolic acidosis, hyperkalaemia, hyperlipidaemia, rhabdomyolysis, cardiac arrhythmia, cardiac arrest, cardiac failure, renal failure, hepatomegaly, hepatitis, acute hepatic failure, Brugada-type ECG, dose-dependent respiratory depression, involuntary movements, priapism, and local pain, swelling and inflammation after accidental extravascular administration (UK SPC §4.8). The footnotes explaining this cluster were truncated at the fetch limit
  • Frequency not known: euphoric mood, drug abuse and drug dependence — §4.4: 'The abuse of and dependence on propofol, predominantly by health care professionals, have been reported'
  • §4.4: 'As with other general anaesthetics, the administration of propofol without airway care may result in fatal respiratory complications'; involuntary patient movements may occur during sedation for operative procedures and 'may be hazardous to the operative site'

Monitoring

  • UK SPC §4.2, verbatim: 'Circulatory and respiratory functions should be constantly monitored (e.g. ECG, pulse oximeter) and facilities for maintenance of patent airways, artificial ventilation, and other resuscitation facilities should be immediately available at all times'
  • Depth of anaesthesia or sedation — the infusion rate is titrated to it in every maintenance and sedation regimen (§4.2)
  • UK SPC §4.4: during conscious sedation for surgical and diagnostic procedures 'patients should be continually monitored for early signs of hypotension, airway obstruction and oxygen desaturation'. US §2.1 adds that these effects 'are more likely to occur following rapid bolus administration, especially in the elderly, debilitated, or ASA-PS III or IV patients'
  • UK SPC §4.4: 'An adequate period is needed prior to discharge of the patient to ensure full recovery after use of propofol'; 'Propofol induced impairment is not generally detectable beyond 12 hours' — advise on being accompanied, on the timing of skilled or hazardous tasks such as driving, and on other sedating agents
  • Line and infusion hygiene as a timed task (§4.2): a continuous infusion from one infusion system 'must not exceed 12 hours'; discard the line, the reservoir and any remaining propofol at that point, and use diluted propofol within 6 hours of preparation

Clinical monograph

How it works

Propofol potentiates inhibitory GABA-A receptor signalling in the central nervous system to produce dose-dependent sedation and anaesthesia; TCI uses a pharmacokinetic model to compute and adjust the infusion rate to reach a chosen target blood or effect-site concentration.

Prescribing in practice

  • It causes dose-dependent respiratory depression and hypotension and abolishes airway reflexes, so it must only be used by those trained in anaesthesia and airway management with full monitoring and resuscitation equipment.
  • Prolonged high-dose infusion, especially in critically ill or paediatric patients, risks propofol infusion syndrome (metabolic acidosis, rhabdomyolysis, cardiac failure), warranting vigilance and limits on duration and rate.
  • It is formulated in a lipid emulsion that supports microbial growth and contributes to caloric and lipid load, requires strict aseptic handling, and is cautioned in egg or soya allergy; for TIVA an appropriate model and depth-of-anaesthesia awareness are needed to avoid accidental awareness.

Monitoring

Monitor depth of anaesthesia, oxygenation, ventilation and cardiovascular status continuously, with processed EEG/depth monitoring advised when neuromuscular blockade is co-administered.

Counselling the patient

  • This is an anaesthetic given by a precisely controlled drip to keep the patient asleep during surgery.
  • Pain on injection into the vein is common and the team can take steps to reduce it.
  • Breathing and blood pressure are monitored and supported throughout.

Evidence & guidelines

Propofol TCI/TIVA is well established, and the Association of Anaesthetists guidance on safe TIVA practice recommends depth-of-anaesthesia monitoring to reduce the risk of accidental awareness.

Reference: PRIS case series; RCoA guidelines; SPC Diprivan; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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