Adults younger than 55 yr of age:IV Induction 40 mg every 10 sec until onset. Usual dose is 2 to 2.5 mg/kg total. For maintenance infusion, titrate to 100 to 200 mcg/kg/min (6 to 12 mg/kg/h). For maintenance intermittent bolus, use 25 to 50 mg increments, as needed.
Elderly, Debilitated, or ASA III/IV: (American Society of Anesthesiologists classification of heart disease, cardiac function, angina, and physical status used to assign risk for anesthesia.) IV 20 mg every 10 sec until onset. Usual dose is 1 to 1.5 mg/kg. For maintenance infusion, titrate to 50 to 100 mcg/kg/min (3 to 6 mg/kg/h).
Neurosurgical patients:IV Induction 20 mg every 10 sec until onset. Usual dose is 1 to 2 mg/kg. For maintenance infusion, use 100 to 200 mcg/kg/min (6 to 12 mg/kg/h).
Children at least 3 yr of age:IV Induction 2.5 to 3.5 mg/kg over 20 to 30 sec. For maintenance infusion (at least 2 mo), use 200 to 300 mcg/kg/min immediately following the induction dose, then, after the first 30 min of maintenance, use infusion rates of 125 to 150 mcg/kg/min titrated to achieve the desired clinical effect, are typically needed.
Adults younger than 55 yr of age:IV Initiation 100 to 150 mcg/kg/min (6 to 9 mg/kg/h) for 3 to 5 min (preferred method) or slow injection of 0.5 mg/kg over 3 to 5 min; follow by maintenance infusion. For maintenance, use 25 to 75 mcg/kg/min (1.5 to 4.5 mg/kg/h) (preferred method) or incremental bolus doses of 10 to 20 mg.
Elderly, Debilitated, or ASA III/IV:IV Initiation Same as adults; not as rapid bolus. For maintenance, use 20% reduction of adult dose; avoid rapid bolus doses.
Adults:IV Initiation 5 mcg/kg/min (0.3 mg/kg/h) for at least 5 min; increments of 5 to 10 mcg/kg/min (0.2 to 0.6 mg/kg/h) over 5 to 10 min may be used until desired level of sedation is achieved. For maintenance, use 5 to 50 mcg/kg/min (0.3 to 3 mg/kg/h) or higher may be required; use minimum dose required for sedation.
Produces sedation/hypnosis rapidly (within 40 sec) and smoothly with minimal excitation; decreases IOP and systemic vascular resistance; rarely is associated with malignant hyperthermia and histamine release; suppresses cardiac output and respiratory drive.