Induction and maintenance of monitored anesthesia care (MAC) sedation; combined sedation and regional anesthesia; and ICU sedation of intubated, mechanically ventilated adult patients. Induction of general anesthesia in patients ≥3 years of age. Maintenance of general anesthesia in patients ≥2 months of age.
See literature. Individualize. Allow 3–5 minutes between dose adjustments. General anesthesia induction (<55yrs): 40mg every 10 seconds until induction onset. Elderly, debilitated, ASA-PS III or IV, cardiac anesthesia, neurosurgery: 20mg every 10 seconds until induction onset. General anesthesia maintenance as infusion (<55yrs and neurosurgery): initially 100–200microgram/kg/min for 10–15 minutes, reduce to 50–100microgram/kg/min. Elderly, debilitated, ASA-PS III or IV: 50–100microgram/kg/min. Cardiac anesthesia: As the primary agent: 100–150microgram/kg/min; with primary opioid: 50–100microgram/kg/min. General anesthesia maintenance as intermittent bolus (<55yrs): increments of 20–50mg as needed. Initiation of MAC sedation: give by slow infusion of 100–150microgram/kg/min for 3–5 minutes or slow injection of 0.5mg/kg over 3–5 minutes followed immediately by maintenance infusion. Maintenance of MAC sedation (<55yrs): infuse 25–75microgram/kg/min (preferred) or give incremental boluses of 10mg or 20mg; elderly, debilitated, ASA-PS III or IV, neurosurgical patients: reduce dose by 20%. ICU sedation: initially infuse 5 microgram/kg/min for at least 5 minutes; increase in increments of 5–10microgram/kg/min over 5–10minutes until clinical effect is achieved. Maintenance: 5–50microgram/kg/min or higher; continue until 10–15 minutes prior to extubation. May give 10mg or 20mg bolus to rapidly increase depth of sedation in patients not at risk of hypotension.
Individualize. General anesthesia induction (3–16yrs): 2.5–3.5mg/kg given over 20–30 seconds. General anesthesia maintenance (2mos–16yrs): 125–300microgram/kg/min, decrease infusion rate if signs of light anesthesia are not present following the first ½ hour.
Egg or soy product allergy.
Should be administered only by persons trained in the administration of general anesthesia. Keep resuscitative equipment, artificial ventilation and oxygen readily available; maintain patency of the airway at all times. Initiate drug holiday and supplement lost zinc if infused for >5 days (esp. patients with burns, diarrhea, major sepsis). Hyperlipoproteinemia. Diabetic hyperlipemia. Pancreatitis. Seizure disorder. Increased intracranial pressure. Impaired cerebral circulation. Cardiac depression. Hemodynamically unstable. Correct fluid deficits before administration. Monitor cardiorespiratory status, renal function, triglycerides, serum zinc. Avoid abrupt cessation. American Society of Anesthesiologists Physical Status (ASA-PS) III or IV, elderly debilitated: avoid rapid bolus administration. Labor & delivery, nursing mothers: not recommended. Pregnancy (Cat.B).
Potentiation with volatile inhalational anesthetics (eg, enflurane, isoflurane, halothane), parental narcotics (eg, morphine, meperidine, fentanyl) or combinations of opioids and sedatives (eg, benzodiazepines, barbiturates, choral hydrate, droperidol), other CNS depressants; reduce dose. Children: concomitant fentanyl may cause serious bradycardia.
Hypotension, bradycardia, inj site pain, apnea, propofol infusion syndrome with high-dose infusions (>5mg/kg/h for >48hrs); rare: anaphylaxis, phlebitis, thrombosis, perioperative myoclonia. Children: also movement, hypertension, rash, pruritis, tachycardia nodal, arrhythmia.
Ready-to use vial (20mL, 50mL, 100mL)—1