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      Propofol

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Medications	Dosing for Endoscopic Sedation	Reversal Agents
Opioids
Meperidine (Demerol)	Initial Dose: 25-50 mg Additional doses: doses of 25 mg can be administered every 2-5 minutes until adequate Onset of action: 3-6 min Peak effect: 6-7 min Duration of effect: 60-180 min	Naloxone
Fentanyl (Sublimaze)	Initial dose:  50-100 mcg Additional doses: doses of 25 mcg can be administered every 2-5 minutes until adequate sedation is achieved Onset of action: 1-2 minutes Peak effect: 3-5 minutes Duration of effect: 30-60 minutes	Naloxone
Benzodiazepines
Diazepam (Valium)	Initial dose:  5-10 mg Onset of action:  2-3 min Peak effect: 3-5 min Duration of effect:  360 min	Flumazenil
Midazolam (Versed)	Initial dose:  1-2 mg Additional doses: 1 mg administered at 2-minute intervals Onset of action:  1-2 minutes Peak effect: 3-4 minutes Duration of effect:  15-80 minutes	Flumazenil
Reversal Agents
Naloxone (Narcan)	Initial dose:  0.1-0.2 mg Additional doses: 0.2-0.4 mg administered intravenously every 2-3 minutes until desired response is attained. Supplemental dose may be necessary after 20-30 minutes. Onset of action:  1-2 minutes Peak effect: 5 min Duration of effect:  30-45 minutes	None
Flumazenil (Romazicon)	Initial dose:  0.2 mg administered intravenously over 15 seconds* Additional doses: If desired consciousness is not reached within 45 seconds, up to 4 additional doses 0.2 mg can be administered at 60 second intervals up to maximum dose Onset of action:  1-2 minutes Peak effect:  3 minutes Duration of effect:  10-15 minutes Repeat treatment: If resedation occurs, repeated doses can be administered at 20 minute intervals. No more than 1 mg (given as 0.2 mg/min) should be administered at any one time. No more than 3 mg should be given in any one hour.	None
Anesthetic Agents
Propofol (Diprivan	Initial dose:  10-40 mg    Additional doses: IV dose of 25-75 mcg/kg per minute; or incremental IV bolus doses of 10-20 mg   Onset of action: less than 1 minute Peak effect: 1-2 minutes Duration of effect: 4-8 minutes	None
Other Drugs
Ketamine (Ketalar)	Initial IV dose: 0.5 mg/kg Additional doses: Titrate to effect Onset of action: Less than 1 minutes Peak effect: 1 minutes Duration of effect: 10-15 minutes	None
Nitrous Oxide (Kalinox)	Initial dose: Titrate to effect Onset of action: 2-3 minutes Peak effect: Dose dependent Duration of effect:  15-30 minutes	None
Diphenydramine (Benadryl Injection)	Initial dose:  25-50 mg up to100mg if required  Onset of action:  2-3 minutes Peak effect:  60-90 minutes Duration of effect:  More than 240 minutes	None
Promethazine (Phenergan)	One time dose:  12.5- 50 mg Onset of action:  2-5 minutes Peak effect:  Unknown Duration of effect: More than 120 minutes	None
Droperidol (Inapsine)	Initial dose:  1.25-2.5 mg via IM  or slow IV Additional doses: Additional 1.25 mg doses may be administered to achieve the desired effect Onset of action: 3-10 minutes Peak effect: 30 minutes Duration of effect: 120-240 minutes	None
Adjunct Agents
Atropine (Atropine Sulfate)	Initial dose:  0.4-0.6 mg Additional doses: 0.4-0.6 mg  Onset of action:  45-60 seconds Peak effect: 2 minutes Duration of effect:  1-2 hours	None
Glucagon (GlucaGen)	Dose: 0.25-0.5 mg Onset of action:  1 minute Duration of effect: 9-17 minutes -OR- Dose: 2 mg* Onset of action: 1 minute Duration of action: 22-25 minutes *Use of 2mg dose produces a higher incidence of nausea and vomiting than do lower doses.	None
		Last Updated 3/1/2011