Propofol
Propofol CRI for two indications: total IV anesthesia (TIVA) maintenance in dogs, and refractory status epilepticus in dogs and cats. Propofol does NOT provide analgesia. Multimodal analgesia must be added for surgical procedures.
- No analgesia. Propofol is a sedative- hypnotic with no analgesic activity. Add multimodal analgesia (opioid, local block, NSAID where appropriate) for surgical procedures.
- Continuous monitoring required. Respiratory and cardiovascular support must be immediately available, apnea is possible, especially with rapid administration. Endotracheal intubation capability and supplemental oxygen are mandatory.
- Cat TIVA not supported by this calculator. Cats are susceptible to long recoveries and Heinz-body anemia with repeated/prolonged propofol exposure. Use short procedures with intermittent propofol bolus, or consider alfaxalone CRI or inhalant maintenance instead. (Status epilepticus protocol IS available for cats, select that indication.)
TIVA maintenance, short procedures or
inhalant-contraindicated general anesthesia (dog-only).
Range 0.1–0.5 mg/kg/min IV CRI.
Refractory status epilepticus, alternative
to barbiturates with less cardiorespiratory depression
(dogs and cats). Range 0.1–0.25 mg/kg/min IV CRI, preceded
by a 2–8 mg/kg IV bolus titrated to effect. Maintain
6–12 hr then taper; max ≈48 hr.
Enter a patient weight to see the result.
How the calculation works
Propofol stock is 10 mg/mL (1% emulsion). The dose is in mg/kg/min. Converting to a pump rate:
Multiplying by 60 converts the per-minute dose to per-hour so the pump rate (mL/hr) matches the standard syringe-driver convention.
Worked example with current inputs
Enter a patient weight to see the worked example.
Induction dose reference (Plumb's, label data)
Induction dosing is a clinical judgment, not a calculation. Plumb's explicitly states: "all dosages are provided for guidance only and individual animal response should dictate the dose used." Premedications reduce induction requirements substantially (commonly 25–60% lower than unpremedicated). The tables below are reproduced from the Plumb's monograph for bedside reference.
Propofol induction dose in dogs, by premedication protocol
| Premedication protocol | Propofol dose (mg/kg) | Rate (sec) | Note |
|---|---|---|---|
| None | 5.5 – 7.6 | 40–90 sec | Healthy adult dog, no premed |
| Acepromazine | 3.7 – 4.4 | 30–90 sec | |
| Xylazine | 2.2 – 3.3 | 60–90 sec | |
| Medetomidine | 2.2 – 2.8 | 60–90 sec | |
| Acepromazine + opioid | 2.6 – 4.7 | 30–90 sec | Wider range across product labels |
| Benzodiazepine + opioid | 4.0 | 60–90 sec | |
| α₂ agonist + opioid | 3.2 | 60–90 sec |
Propofol induction dose in cats, by premedication protocol
| Premedication protocol | Propofol dose (mg/kg) | Rate (sec) | Note |
|---|---|---|---|
| None | 8 – 13.2 (label), 2–8 (extra-label, titrated) | 60–90 sec | Label range often considered higher than necessary |
| Acepromazine, butorphanol, oxymorphone | 8 – 13.2 (label) | 60–90 sec | Reduce when premedicated; titrate to effect |
| Xylazine | 7 – 12 (label) | 60–90 sec | |
| α₂ agonist (eg dexmedetomidine) | ≈4–7 (extra-label) | 60–90 sec | Dexmedetomidine premed reduces propofol induction dose by ≈49% in cats |
IV administration over 30–90 seconds. Rapid injection (<5 sec) is associated with apnea; too-slow injection results in inadequate plane of anesthesia (titrate additional incremental doses if needed). Premedication-induced excitation can be minimized by giving ≈1 mg/kg propofol slowly first, then the benzodiazepine, then the remainder of the propofol titrated to effect.
Cautions and populations
Cats, repeated or prolonged exposure
Plumb's notes that repeated or prolonged propofol use in cats has been associated with increased Heinz-body production, anorexia, lethargy, malaise, and diarrhea. Cats are also susceptible to long recoveries due to slower glucuronidation. Keep CRI duration short. Monitor CBC for Heinz-body anemia with repeat exposure.
Greyhounds and sighthounds
Greyhounds metabolize propofol more slowly than other breeds due to decreased CYP2B11 expression. Recovery may be prolonged after multiple repeated doses or CRI. Recovery is generally normal after 1–2 induction boluses, especially when followed by inhalant maintenance. Effects in other sighthounds are not well characterized, caution is warranted.
Debilitated patients
Lower doses are required in debilitated, geriatric, or critically ill patients. Cardiovascular and respiratory depression may be exaggerated. Combined with other CNS depressants (acepromazine, opioids, benzodiazepines), reduce the dose by 40–60% from the single-agent dose.
Drug interactions
- Epinephrine: propofol enhances epinephrine-induced arrhythmias in a dose-dependent manner, use caution if epinephrine is also indicated.
- α₂ agonists (dexmedetomidine, medetomidine): risk of hypoxemia; reduce propofol dose 30–60%.
- Opioids: reduce propofol requirements; serum concentrations of both drugs may be increased.
- Benzodiazepines: increased risk of hypothermia; midazolam plasma concentrations may increase up to 20%.
- Hepatic P-450 inhibitors (chloramphenicol, cimetidine, ketoconazole): may prolong recovery.
Propofol infusion syndrome
Rare complication reported with prolonged human and (very rarely) canine propofol CRIs. Clinical signs: metabolic acidosis, rhabdomyolysis, hyperlipidemia, cardiac arrhythmias, cardiac and renal failure. Risk increases with duration. Plumb's recommends maximum status epilepticus CRI duration of ≈48 hours. Discontinue and treat supportively if syndrome is suspected.
Sources
- Plumb's Veterinary Drugs, propofol monograph (current edition). Sections used: Prescriber Highlights, Uses/ Indications, Pharmacology/Actions, Pharmacokinetics, Contraindications/Precautions/Warnings, Adverse Effects, Overdose/Acute Toxicity, Drug Interactions, Dosages (label and extra-label, dogs and cats), Storage/Stability, Compatibility/Compounding Considerations, Dosage Forms/ Regulatory Status.