General Anesthesia
- IV (Adults <55 yr): Induction: 40 mg every 10 sec until induction achieved (2–2.5 mg/kg total). Maintenance: 100–200 mcg/kg/min. Rates of 150–200 mcg/kg/min are usually required during first 10–15 min after induction, then ↓ by 30–50% during first 30 min of maintenance. Rates of 50–100 mcg/kg/min are associated with optimal recovery time. May also be given intermittently in increments of 25–50 mg.
- IV Geriatric Patients , Cardiac Patients, Debilitated Patients, or Hypovolemic Patients): Induction: 20 mg every 10 sec until induction achieved (1–1.5 mg/kg total). Maintenance: 50–100 mcg/kg/min (dose in cardiac anesthesia ranges from 50–150 mcg/kg/min depending on concurrent use of opioid).
- IV (Adults Undergoing Neurosurgical Procedures): Induction: 20 mg every 10 sec until induction achieved (1–2 mg/kg total). Maintenance: 100–200 mcg/kg/min.
- IV (Children ≥3 yr–16 yr): Induction: 2.5–3.5 mg/kg, use lower dose for children ASA III or IV.
- IV (Children 2 mo–16 yr): Maintenance: 125–300 mcg/kg/min (following first 30 min of maintenance, rate should be ↓ if possible), younger children may require larger infusion rates compared to older children.
Monitored Anesthesia Care Sedation
- IV (Adults <55 yr): Initiation: 100–150 mcg/kg/min infusion or 0.5 mg/kg as slow injection. Maintenance: 25–75 mcg/kg/min infusion or incremental boluses of 10–20 mg.
- IV Geriatric Patients , Debilitated Patients, or ASA III/IV Patients): Initiation: Use slower infusion or injection rates. Maintenance: 20% less than the usual adult infusion dose; rapid/repeated bolus dosing should be avoided.
ICU Sedation
- IV (Adults ): 5 mcg/kg/min for a minimum of 5 min. Additional increments of 5–10 mcg/kg/min over 5–10 min may be given until desired response is obtained. (Range 5–50 mcg/kg/min.) Dose should be reassessed every 24 hr.
