What is the standard propofol induction dose for general anesthesia?

The standard propofol induction dose for healthy adults (ASA I–II) is 1.5–2.5 mg/kg IV, typically administered over 20–30 seconds. For elderly patients (>55 years) or those with higher ASA classification, the dose is reduced to 1–1.5 mg/kg. Pediatric patients aged 3–16 years may require higher doses of 2.5–3.5 mg/kg due to larger volume of distribution.

What is propofol infusion syndrome (PRIS) and how do you prevent it?

Propofol infusion syndrome (PRIS) is a rare but potentially fatal complication characterized by metabolic acidosis, rhabdomyolysis, hyperkalemia, renal failure, and cardiac failure. It is associated with prolonged propofol infusions at rates exceeding 5 mg/kg/hr (83 mcg/kg/min) for more than 48 hours. Prevention includes limiting infusion rates to below 5 mg/kg/hr, monitoring for early signs (rising lactate, triglycerides, CK), and using the lowest effective dose.

How do you calculate propofol infusion rate in mL/hr?

To convert propofol infusion rate to mL/hr using standard 10 mg/mL (1%) concentration: Rate (mL/hr) = Rate (mg/hr) ÷ 10. For example, a 70 kg patient at 150 mcg/kg/min = 630 mg/hr = 63 mL/hr. Alternatively: Rate (mL/hr) = Weight (kg) × Rate (mcg/kg/min) × 60 ÷ 10,000.

Does propofol need to be counted toward ICU nutritional calories?

Yes. Propofol is formulated in 10% soybean oil emulsion (Intralipid), providing 1.1 kcal/mL. At typical ICU sedation rates, this can contribute 200–500+ kcal/day. For example, a propofol infusion at 30 mL/hr provides 33 kcal/hr or approximately 792 kcal/day. This lipid load should be subtracted from the patient's nutritional regimen to avoid overfeeding.

What are the main hemodynamic effects of propofol?

Propofol causes dose-dependent hypotension through arterial vasodilation and direct myocardial depression. Blood pressure typically decreases 15–25% after induction. It also causes apnea in approximately 25–35% of patients following bolus administration. These effects are more pronounced in elderly patients, hypovolemic patients, and those with impaired cardiac function. Slow injection and volume preloading help mitigate hypotension.

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Propofol Dose Calculator

Calculate propofol dosing by clinical indication with infusion rates, volume for 10 mg/mL concentration, and caloric contribution. Supports induction, maintenance, ICU sedation, procedural sedation, and MAC.

Inputs

Patient Weight

Patient Age (years) Dose reduction applied for age >55

ASA Physical Status

Indication

Procedure Duration (minutes) — optional

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Enter weight to calculate propofol dose.

⚠ Hemodynamic Effects

Hypotension: Expect 15–25% decrease in MAP after induction. More pronounced in elderly, hypovolemic, and cardiac-impaired patients. Consider volume preloading and slow administration.
Apnea: Occurs in 25–35% of patients after bolus. Have airway equipment and positive-pressure ventilation immediately available.

Disclaimer: For educational purposes only. Always verify doses with your institution's formulary and pharmacy. Not a substitute for clinical judgment.

Contraindications & Cautions

⚠ Contraindications

Known hypersensitivity to propofol, soy, or egg lecithin
Allergies to egg or soy products — though true cross-reactivity is rare, exercise caution
Not recommended for ICU sedation in pediatric patients — increased PRIS risk in children
Severe hemodynamic instability — risk of cardiovascular collapse
Impaired lipid metabolism — disorders such as primary hyperlipoproteinemia, diabetic hyperlipemia, or pancreatitis

📋 Propofol Infusion Syndrome (PRIS)

A rare but life-threatening complication of prolonged, high-dose propofol infusion. Risk factors include infusion rates >5 mg/kg/hr for >48 hours, catecholamine or steroid co-administration, critical illness, and pediatric ICU patients. Clinical features include:

Metabolic acidosis (unexplained lactic acidosis)
Rhabdomyolysis (elevated CK)
Hyperkalemia
Hepatomegaly / hepatic steatosis
Renal failure
Cardiac failure / Brugada-like ECG pattern
Hypertriglyceridemia

Prevention: Limit infusion to <5 mg/kg/hr (83 mcg/kg/min). Monitor lactate, CK, triglycerides, and pH regularly. Switch to alternative agents (dexmedetomidine, midazolam) for prolonged ICU sedation.

Clinical Pearls

Injection pain: Propofol injection causes pain in 28–90% of patients. Pre-treatment with lidocaine 0.5 mg/kg IV (or mixing 20 mg lidocaine per 200 mg propofol) with venous occlusion for 30–60 seconds significantly reduces pain.
Egg/soy allergy: The allergenic components of eggs (ovalbumin) and soy (soy protein) differ from the egg lecithin and soybean oil used in propofol. True cross-reactivity is extremely rare, but always exercise clinical judgment.
Obesity: Use total body weight (TBW) for induction bolus but consider lean body weight for maintenance infusion to avoid excessive dosing.
Elderly (>55 years): Reduce induction dose by 30–50%. Use slower injection rates (20–40 mg every 10 seconds). Increased sensitivity due to reduced cardiac output and delayed redistribution.
Bacterial contamination: Propofol supports microbial growth. Discard unused portions within 6–12 hours of opening. Use strict aseptic technique.
Green urine: Propofol metabolites may cause green discoloration of urine — benign and resolves upon discontinuation.

References

Miller RD, et al. Miller's Anesthesia, 9th Edition, Chapter 30: Intravenous Anesthetics. Elsevier, 2020.
Lexicomp. Propofol: Drug Information. UpToDate/Lexicomp, 2024.
Roberts RJ, Barletta JF, Fong JJ, et al. Incidence of propofol-related infusion syndrome in critically ill adults: a prospective, multicenter study. Crit Care. 2009;13(5):R169.
UpToDate. General anesthesia: Intravenous induction agents. Wolters Kluwer, 2024.
Hemphill S, McMenamin L, Bellamy MC, Hopkins PM. Propofol infusion syndrome: a structured literature review and analysis of published case reports. Br J Anaesth. 2019;122(4):448-459.

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About This Tool

What Is Propofol?

Propofol (2,6-diisopropylphenol) is a short-acting intravenous anesthetic agent widely used for induction and maintenance of general anesthesia, procedural sedation, and ICU sedation. Introduced in 1986, it is formulated as a lipid emulsion (10% soybean oil, 2.25% glycerol, 1.2% egg lecithin) and acts primarily through potentiation of GABA_A receptors. Its rapid onset (15–30 seconds) and short duration of action (5–10 minutes after a single bolus) make it ideal for both brief and prolonged procedures.

Dosing by Indication

General Anesthesia — Induction: The standard adult induction dose is 1.5–2.5 mg/kg IV administered over 20–30 seconds (approximately 40 mg every 10 seconds until loss of consciousness). Elderly patients (>55 years) require lower doses of 1–1.5 mg/kg due to decreased cardiac output and volume of distribution. Pediatric patients aged 3–16 years typically require higher doses of 2.5–3.5 mg/kg. Patients with ASA III–V classification should receive reduced doses with slower administration.

General Anesthesia — Maintenance (TIVA): Total intravenous anesthesia with propofol uses infusion rates of 100–200 mcg/kg/min (6–12 mg/kg/hr). Rates are titrated to clinical effect, BIS monitoring (target 40–60), and hemodynamic parameters. Higher rates may be needed during stimulating surgical phases. The infusion rate typically decreases over time as drug accumulates in peripheral compartments.

ICU Sedation: For mechanically ventilated adults, propofol is initiated at 5 mcg/kg/min and titrated in increments of 5–10 mcg/kg/min every 5–10 minutes to achieve the desired sedation level (typically RASS 0 to −2). The usual range is 5–50 mcg/kg/min (0.3–3 mg/kg/hr). Monitor for PRIS: keep rates below 5 mg/kg/hr (83 mcg/kg/min) and monitor lactate, CK, triglycerides.

Procedural Sedation (ED): An initial bolus of 0.5–1 mg/kg IV is administered over 20–30 seconds, followed by supplemental doses of 0.25–0.5 mg/kg every 3–5 minutes as needed. This provides moderate-to-deep sedation with rapid recovery. Dedicated airway management skills and monitoring are essential.

MAC / Monitored Sedation: For monitored anesthesia care, propofol is infused at 25–75 mcg/kg/min (1.5–4.5 mg/kg/hr), often with an initial bolus of 0.25–0.5 mg/kg. This provides anxiolysis and light sedation while maintaining spontaneous ventilation. Commonly used for endoscopy, cataract surgery, and minor procedures.

Pharmacokinetics

Parameter	Value
Onset (IV bolus)	15–30 seconds
Peak effect	1–2 minutes
Duration (single bolus)	5–10 minutes
Distribution half-life	2–4 minutes
Elimination half-life	4–7 hours (context-sensitive)
Metabolism	Hepatic (CYP2B6) + extrahepatic conjugation
Protein binding	97–99%

🔑 Clinical Pearls

Titrate to effect: Always titrate propofol to clinical response. Stated doses are starting ranges — individual requirements vary widely based on concurrent medications, comorbidities, and procedural stimulation.
Context-sensitive half-time: Despite a long elimination half-life, propofol's context-sensitive half-time remains relatively short (<25 min for infusions up to 8 hours) due to rapid redistribution, allowing predictable emergence.
Injection pain mitigation: Pre-treat with lidocaine 0.5 mg/kg IV into a large antecubital vein with 30–60 seconds of venous occlusion. Alternatively, mix lidocaine 20 mg per 200 mg propofol.
Lipid calories count: At 1.1 kcal/mL, a propofol infusion at 30 mL/hr adds ~792 kcal/day. Always account for this in ICU nutrition calculations.

Key References

Miller RD, et al. Miller's Anesthesia, 9th Edition, Ch. 30. Elsevier, 2020.
Roberts RJ, et al. Incidence of propofol-related infusion syndrome in critically ill adults. Crit Care. 2009;13(5):R169.
Hemphill S, et al. Propofol infusion syndrome: structured literature review. Br J Anaesth. 2019;122(4):448-459.

Formula last verified: February 2026