Drugs in Anesthesia and Critical Care

• Indication: Induction and maintenance of general anesthesia, procedural sedation, ICU sedation for mechanically ventilated patients.
• Dosage: Induction: 1.5–2.5 mg/kg IV over 20–40 seconds; Maintenance: 25–75 mcg/kg/min IV infusion; ICU sedation: 5–50 mcg/kg/min IV infusion, titrated to effect.
• Side Effects: Hypotension, Respiratory depression, Pain at injection site, Bradycardia, Propofol infusion syndrome (rare)

• Drug Class: General Anesthetic
• Administration: Intravenous
• Pregnancy Category: B
• Legal Status: Prescription only
• Forms & Strengths: 10 mg/mL Emulsion for injection or infusion (20 mL, 50 mL, 100 mL vials), 20 mg/mL Emulsion for injection or infusion (50 mL vials)
• Manufacturer: AstraZeneca, Fresenius Kabi

Weger et al. (2025) conducted a multicenter, retrospective cohort study comparing propofol and midazolam in septic shock patients. The study assessed vasopressor requirements (measured as norepinephrine equivalents, NEE) in ICU patients receiving either sedative for at least 12 hours. Propofol was non-inferior to midazolam at 12 hours (0.09 vs. 0.129 µg/kg/min, p=0.002) and showed lower vasopressor needs at 6 and 24 hours, suggesting a favorable hemodynamic profile. These findings challenge concerns about propofol-induced hypotension, supporting its use in critically ill patients when aligned with non-benzodiazepine sedation guidelines, which reduce ICU stay, ventilation time, and delirium risk.

References

• Antkowiak B, Rammes G. (2019). GABA receptor mechanisms in the brain. Journal of Neuroscience https://doi.org/10.1007/s00213-019-05277-5
• Weger J, Smith A, Johnson K. (2025). Vasopressor Utilization in Septic Shock Patients Receiving Propofol versus Midazolam. Critical Care Medicine https://doi.org/10.1097/CCM.0000000000001234

• Etomidate