I have received some comments on this page stating concerns regarding the use of propofol in pediatric patients. This page was written at a time and place where propofol was used for procedures in a PICU setting with full life support equipment available -- essentially an anaesthesia unit. This web page is not an endorsement of propofol for any particular use. If best practices change locally or globally, the page cannot keep up with those changes, so find out for yourself. Also see the site's disclaimer.
Propofol (Diprivan) can be used as a general anaesthetic; it's rapid onset of action (and recovery) make it easy to titrate and relatively safe. It is given intravenously so its absorption is reliable, unlike chloral hydrate. The drug is prepared in a lipid suspension which contains egg and soy protein; consequently, patient allergies to either protein are a counterindication. Primary side effects include hypotension, usually reversible by decreasing the amount of propofol and/or administering fluid boluses. If the plane of anaesthesia is too deep, the patient's gag reflex or respiratory drive may be impaired, threatening the airway or making the patient apneic. For this reason, intubation supplies should be available (working laryngoscope with appropriate blade, correctly sized ET tube and stylet, bag and mask ventilation system with oxygen). The patient should be NPO for an adequate period prior to sedation. The patient should be placed on a CR monitor with continuous pulse oximetry and frequent blood pressure measurements prior to and during the procedure. Infusion of propofol through peripheral veins produces a burning sensation. If a peripheral vein is used, the induction dose of propofol is usually mixed nine parts propofol to one part of 1% lidocaine. Since the toxic dose of lidocaine is about 5 mg/kg, be aware how much lidocaine is used and make sure it is only present in the inducing dose. Propofol is provided as a 10 mg/mL solution. It should be administered slowly to lessen hypotensive side effects. When no more propofol is required, the remaining amount in the line should be drawn back if possible and the line should be flushed. After the procedure, the patient should continue to be monitored by personnel in the same room until the patient returns to their baseline status.
The intial loading dose of propofol is 1 mg/kg I.V. This is followed by 0.25-0.5 mg/kg maintenance boluses every 1-2 minutes, as required. Propofol is not recommended for patients with hypovolemia or hemodynamic instability, and if it must be used in such patients, doses which are half of the above doses are recommended.
A T-connector is inserted into the IV line. Guess at the number of 10 cc syringes likely to be used during the procedure (more can be drawn up if the procedure goes long). Draw up 10 cc propofol in each syringe; in the first syringe, draw up 9 cc, plus one cc of 1% lidocaine to be used for induction. Administer the induction dose and monitor the plane of anaesthesia. If more is required, give slow boluses of about 1 mg/kg. During the procedure, titrate the boluses to effect. Monitor the patient for movement, elevation of blood pressure or heart rate. Maintain the anaesthesia with intermittent boluses. During particularly painful portions of procedures, additional boluses may be required.
This method is preferable for longer procedures, and for larger patients. The loading dose is 2 mg/kg given as a slow push. The patient can then be placed on a drip of 100 micrograms/kg/minute (which should be programmed into the IV pump as cc/hour). A syringe with additional propofol can either be attached to T-connector or the infusion pump can be programmed to provide 0.5 mg/kg boluses. These boluses can be given as per the manual method.