Editor's note: This corrects an earlier version that read mg instead of mcg in the explanation of the bolus.
Propofol offers rapid induction, but its use is not always free of complications. For example, a propofol loading dose of 2 mg/kg can be given at 400 mcg/kg/min over 5 minutes, 300 mcg/kg/min over 7.5 minutes, or 200 mcg/kg/min over 10 minutes to avoid hemodynamic instability, respiratory arrest or airway obstruction. Alternatively, minibolus method using 150 mcg/kg IV every 20 seconds PRN. After loading dose, administer 50 to 150 mcg/kg/min titrated based on clinical criteria. This can help prevent apnea and hypotension, which requires mask ventilation or intubation, fluid boluses and vasopressors.
At first glance, the approach may appear "inefficient" to the observer, but it may save time by preventing a resuscitation circus.
Daniel K. O'Neill, M.D.
Assistant Professor of Anesthesiology
NYU Langone Medical Center
New York, N.Y.
