Propofol: uses, how it works, side effects

Propofol is the drug that, within a few seconds, puts most patients who enter the operating room to sleep. It is an intravenous anesthetic with an unmistakable look, a liquid as white as milk, and today it is the starting point of almost every general anesthesia and of many sedations for tests and minor procedures.

What propofol is

Propofol (2,6-diisopropylphenol) is an intravenous hypnotic drug: it induces pharmacological sleep, but on its own it does not relieve pain. It comes as a lipid emulsion, that is, an emulsion of fats in water, which is why it is milky white. It entered clinical practice in the 1980s and within a few years replaced most of the earlier intravenous anesthetics, such as thiopental, which was used before, because it allows a quick awakening without significant lingering sedation. It is used only in hospitals or properly equipped facilities, and only staff trained in anesthesia give it: the margin between a useful dose and one that depresses breathing and circulation is narrow, which means that very little is enough to reach a dose with potentially serious consequences.

How propofol works

Propofol enhances the effect of GABA, the main inhibitory neurotransmitter of the brain, by acting on the GABA-A receptor. As a result, the activity of neurons slows down, until consciousness is lost. The drug is highly fat-soluble: this is why it reaches the brain within a few seconds after the injection and, just as quickly, redistributes into the tissues, and the patient wakes up within a few minutes when the administration stops. This profile explains its success: the anesthesiologist can adjust its effect almost in real time, also with target-controlled infusion pumps guided by pharmacokinetic models. Its effects add up to those of other hypnotics and are strongly enhanced by opioids: in anesthesia this interaction is intended, but it requires lower doses when the drugs are used together.

What propofol is used for

1. Induction of general anesthesia. It is the drug most often used to put the patient to sleep at the start of surgery, before intubation.
2. Maintenance of anesthesia. As a continuous infusion, alone or with other drugs (total intravenous anesthesia).
3. Sedation for tests and procedures. Endoscopies, cardioversions, minor procedures: from conscious sedation to deep sedation, depending on the dose.
4. Sedation in intensive care of ventilated adult patients, for limited periods.

In my practice as an anesthesiologist, propofol is the drug I use most often of all, for many purposes, from short sedation to deep anesthesia: I tell patients that it is the same drug as the burning in the arm they may have heard about, and that sleep comes before the discomfort becomes a memory.

Intravenous propofol dosage

Propofol is not taken by the patient: it is given only intravenously, in hospitals or properly equipped facilities, and the anesthesiologist calculates the dose based on the patient's response, age, weight, clinical condition and other medicines in use. The doses below come from the prescribing information approved by the U.S. Food and Drug Administration (FDA) for DIPRIVAN (propofol) injectable emulsion, September 2025 edition, and are given for orientation only: doses and approved uses can differ from country to country, and they must always be checked with the doctor treating you in your own country.

Indication	Adult	Child	Duration
Induction of anesthesia	2-2.5 mg/kg in healthy adults under 65; 1-1.5 mg/kg in elderly, debilitated or ASA III-IV patients	2.5-3.5 mg/kg in healthy children from 3 to 16 years of age	until sleep onset
Maintenance of anesthesia	6-12 mg/kg/hour (100-200 mcg/kg/min) in healthy adults under 65; 3-6 mg/kg/hour in elderly, debilitated or ASA III-IV patients	7.5-18 mg/kg/hour (125-300 mcg/kg/min) in healthy children from 2 months to 16 years of age	length of surgery
Sedation for procedures	6-9 mg/kg/hour for 3-5 minutes, or 0.5 mg/kg injected slowly over 3-5 minutes; then 1.5-4.5 mg/kg/hour (80% of this dose in elderly, debilitated or ASA III-IV patients)	not indicated	length of the procedure
Sedation in intensive care (intubated, ventilated adults)	start at 0.3 mg/kg/hour for at least 5 minutes, then usually 0.3-3 mg/kg/hour; above 4 mg/kg/hour only if the benefits outweigh the risks	not indicated	no maximum duration set; the dose is reassessed every day

The FDA prescribing information states that safety and effectiveness have been established for induction of anesthesia from 3 years of age and for maintenance from 2 months of age. It gives separate ranges for cardiac anesthesia and for neurosurgical patients. Source: DIPRIVAN prescribing information, Fresenius Kabi USA, September 2025 edition (DailyMed).

The drug is injected into a vein in the arm or hand; the anesthesiologist often combines it with an opioid and, sometimes, with a little local anesthetic to reduce the burning of the injection.

Side effects

Very common:

• pain or burning at the injection site, lasting a few seconds; how many patients remember it is described in our article on recent research;
• a drop in blood pressure, due to the widening of blood vessels caused by the calcium-antagonist effect of the molecule and to the reduced pumping force (inotropy) of the heart;
• a pause in breathing (apnea) after the induction dose: this is why the anesthesiologist supports breathing from the very first moment.

Common:

• slowing of the heart rate;
• involuntary movements during induction;
• headache on waking up.

Rare:

• allergic reactions;
• propofol infusion syndrome (PRIS): a rare and potentially fatal complication of prolonged, high-dose infusions, with metabolic acidosis, changes in the electrocardiogram and muscle damage. A review of 168 published cases associated mortality in adults, among other factors, with infusion rates above 5 mg/kg/hour.

When to report side effects to the doctor: propofol is used only in hospital, so the warning signs are monitored by the team. After outpatient sedation, it is important to report drowsiness that does not go away, confusion or difficulty breathing.

Contraindications to the use of propofol

Absolute (according to the FDA prescribing information):

• known allergy to propofol or to any component of the emulsion;
• history of anaphylaxis to eggs, egg products, soybeans or soy products.

Relative (precautions):

• patients with cardiovascular instability or with little fluid in circulation, because of the risk of low blood pressure;
• disorders of fat metabolism;
• elderly and frail patients, who need reduced doses.

The FDA prescribing information does not indicate propofol for sedation in intensive care or for procedural sedation in children, because safety and effectiveness have not been established.

Drug interactions

• Opioids (fentanyl, remifentanil, morphine): the effect is strongly enhanced; they are used together on purpose, reducing the dose of each active ingredient.
• Benzodiazepines (midazolam) and other sedatives: effects that add up on sleep and breathing.
• Blood pressure medicines and inhaled anesthetics: they increase the risk of low blood pressure.
• Alcohol and other central nervous system depressants: they add to the sedation; before a test under sedation, the patient must list every medicine taken.

Use in pregnancy and breastfeeding

According to the FDA prescribing information, data collected over several decades in pregnant women, most of them at the time of cesarean delivery, have not identified a drug-associated risk of major birth defects, miscarriage or adverse outcomes for mother and baby. The drug crosses the placenta and may cause depression of the newborn, who should be monitored for reduced muscle tone and sedation. Propofol passes into breast milk; the available data have not shown adverse effects in breastfed infants, and the label asks doctors to weigh the benefits of breastfeeding against the mother's need for the drug. It does not require milk to be discarded. The international indications go in the same direction:

• Association of Anaesthetists (United Kingdom, 2020, updated in 2026): breastfeeding can continue as soon as the mother is awake and able to breastfeed, without discarding milk, because anesthetics, sedatives and painkillers pass into milk in very small amounts.
• LactMed database of the National Institutes of Health (United States): the amounts of propofol in milk are very small and the baby is not expected to absorb them, and most recommendations allow breastfeeding to resume as soon as the mother has recovered from anesthesia, without discarding milk; one group of experts instead advises suspending it for an unspecified time.

In other countries the product information can be more restrictive (in Italy and Spain, for example, it asks to stop breastfeeding for 24 hours). What to do should be decided together with the anesthesiologist, ideally during the visit before surgery.

What to do in case of overdose

Propofol overdose happens only in a healthcare setting, because the drug is not available outside hospital. The expected symptoms are excessively deep sleep, stopped breathing and a severe drop in blood pressure. There is no antidote: breathing and circulation are supported (ventilation, fluids, blood pressure medicines) until the drug is eliminated, which happens within a few minutes. This is why propofol is used only where oxygen, ventilation equipment and trained staff are available.

Clinical insights

Why propofol changed anesthesia

Before propofol, waking up was often slow and accompanied by nausea. Propofol made day surgery and sedation for outpatient tests possible, because the patient becomes clear-headed again in a short time. It also has an anti-nausea effect, which makes it useful in patients who suffer from nausea and vomiting after surgery.

Computer-guided infusion

Target-controlled infusion (TCI) pumps calculate, from pharmacokinetic models, the infusion rate needed to reach the desired concentration in the blood or in the brain. There are many models, each designed for a specific population, and in recent years more general ones have been developed, suitable for adults, children and people with obesity.

Recent research on propofol

• The burning of the injection: how many patients remember it. A study of more than 1,300 patients measured how many remember the discomfort the next day and which measures reduce it: read the article.

Frequently asked questions

Does propofol hurt?

It can cause a burning sensation in the arm for a few seconds, at the moment of the injection. Then you sleep. The anesthesiologist can reduce it by choosing a larger vein or adding a local anesthetic.

How long does the effect of propofol last?

After a single dose, waking up takes a few minutes. After a long infusion it takes a little longer, but it is still short compared with many other anesthetics.

Can I drive after sedation with propofol?

No, not in the following hours: even if you feel clear-headed, reflexes and attention remain reduced. After outpatient sedation you need someone to accompany you.

Can propofol be used in children?

Yes, for anesthesia, with doses adapted to age. According to the FDA prescribing information, safety and effectiveness are established for inducing anesthesia from 3 years of age and for maintaining it from 2 months of age; it is not indicated for sedation in intensive care or for procedural sedation in children. Rules can differ in other countries: ask the anesthesiologist.

Can I drink alcohol after sedation with propofol?

It is better to avoid it for the following 24 hours, because alcohol adds its effects to those of the sedation drugs.

Are there alternatives to propofol?

Yes: other intravenous hypnotics and, for maintenance, inhaled anesthetics. The choice depends on the patient and the procedure, and the anesthesiologist makes it during the anesthesia visit.

References

1. Sahinovic MM, Struys MMRF, Absalom AR. Clinical Pharmacokinetics and Pharmacodynamics of Propofol. Clinical Pharmacokinetics. 2018. PubMed
2. Hemphill S, McMenamin L, Bellamy MC, Hopkins PM. Propofol infusion syndrome: a structured literature review and analysis of published case reports. British Journal of Anaesthesia. 2019. PubMed
3. Anderson BJ, et al. Propofol: A Medication That Changed Pediatric Anesthesia Practice. Paediatric Anaesthesia. 2025. PubMed
4. Fresenius Kabi USA. DIPRIVAN (propofol) injectable emulsion, USP — Prescribing information, September 2025 edition (sections 2, 4, 8.1, 8.2, 8.4). U.S. Food and Drug Administration, label published on DailyMed on 22/09/2025 (accessed 18/10/2026). DailyMed
5. Mitchell J, et al. Guidelines for anaesthesia and sedation for patients who are breastfeeding: Guidelines from the Association of Anaesthetists. Association of Anaesthetists, Anaesthesia. 2026. PubMed
6. Mitchell J, et al. Guideline on anaesthesia and sedation in breastfeeding women 2020: Guideline from the Association of Anaesthetists. Association of Anaesthetists, Anaesthesia. 2020. PubMed
7. Drugs and Lactation Database (LactMed): Propofol. National Institute of Child Health and Human Development, National Institutes of Health. Record updated on 15/02/2021. NCBI Bookshelf
8. Mai D, Rowshan K, Modha D, Chiou K, et al. Propofol injection discomfort recall after monitored anesthesia care or general anesthesia: a prospective observational cohort study. Journal of Anesthesia. 2026. PubMed