ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
IV Induction and Maintenance Agent Pregnancy: Use with caution — crosses placenta; neonatal CNS depression if given at delivery

Propofol

Brand names: Diprivan

Adult dose

Dose: 1.5-2.5 mg/kg IV induction; 4-12 mg/kg/hr infusion (TIVA); 0.3-4 mg/kg/hr (sedation)
Route: Intravenous
Frequency: Continuous infusion (TIVA/sedation); bolus (induction)
Max: Titrated to effect; sedation: 4 mg/kg/hr
Reduce induction dose to 1-1.5 mg/kg in elderly or ASA 3/4. Give slowly (avoid pain on injection — use antecubital fossa or pre-treat with lidocaine 20-40 mg IV). Shake before use (emulsion)

Paediatric dose

Dose: 2.5-3.5 mg/kg IV (induction); 9-15 mg/kg/hr (TIVA) mg/kg
Route: IV
Frequency: Bolus (induction); infusion (maintenance)
Max: Avoid prolonged infusions in children — PRIS risk
Induction: child 1 month to 17 years: 2.5-3.5 mg/kg slow IV. NOT licensed for sedation in ICU patients under 16 due to propofol infusion syndrome (PRIS) risk

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required; context-sensitive half-time increases in severe hepatic impairment

Paediatric weight-based calculator

Induction: child 1 month to 17 years: 2.5-3.5 mg/kg slow IV. NOT licensed for sedation in ICU patients under 16 due to propofol infusion syndrome (PRIS) risk

Clinical pearls

  • PRIS (propofol infusion syndrome): life-threatening metabolic complication at high doses (above 5 mg/kg/hr) for prolonged periods — metabolic acidosis, rhabdomyolysis, hyperkalaemia, cardiac failure; switch to alternative sedation if PRIS suspected
  • Rapid redistribution from brain to peripheral tissues explains short duration of action (5-10 min after single bolus) — context-sensitive half-time increases with prolonged infusions
  • Lipid emulsion: 1% propofol provides 1.1 kcal/mL from fat — factor into nutritional calculations in ICU; change infusion line every 12 hours (infection risk from lipid medium)
  • Reduces CMRO2, ICP, and cerebral blood flow — favourable for neuroanaesthesia; however hypotension from propofol can compromise CPP
  • Antiemetic properties at sub-anaesthetic doses (10-20 mg bolus) — used as rescue antiemetic in PACU

Contraindications

  • Allergy to soya, peanut, or egg (emulsion contains soya oil and egg lecithin)
  • ICU sedation in children under 16 (PRIS risk)

Side effects

  • Hypotension (vasodilation — most significant)
  • Apnoea on induction
  • Pain on IV injection
  • Propofol infusion syndrome (PRIS — rare; metabolic acidosis, rhabdomyolysis, cardiac failure; at doses above 5 mg/kg/hr for more than 48 hours)
  • Urine discolouration (green — harmless)
  • Bradycardia

Interactions

  • Opioids and benzodiazepines (additive CNS/respiratory depression — synergistic; reduce propofol dose)
  • Muscle relaxants (no direct interaction)
  • Antihypertensives (additive hypotension)

Monitoring

  • Blood pressure (continuous intraoperative)
  • Respiratory rate / SpO2
  • Level of sedation (Ramsay/RASS score in ICU)
  • Triglycerides (prolonged ICU use)
  • Signs of PRIS (pH, lactate, CK)

Reference: BNFc; BNF 90; AAGBI Safety Guidelines; Diprivan SPC; Vasile et al. (PRIS Review). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways