Miller’s Anesthesia: IV Drug Delivery Systems †

For analgesia or during sedation, an initial loading dose of remifentanil should not be given
because its very rapid onset may result in apnea or muscle rigidity.

Figure 28-16 Slide rule for calculating the maintenance propofol infusion rate from the patient's
weight, the desired target concentration, and the elapsed time. (Adapted from Bruhn J, Bouillon
TW, Ropcke H, Hoeft A: A manual slide rule for target-controlled infusion of propofol: Development
and evaluation. Anesth Analg 96:142-147, 2003.)

Table 28-5 -- Infusion Rates for Opioids to Achieve Preset Concentrations

Target Plasma
Infusion Rate
Drug Concentration Bolus (µg/kg)
(µg/kg/min)
(ng/mL)

Fentanyl (low) 1 3 0.02

Fentanyl (high) 4 10 0.07

Alfentanil (low) 40 20 0.25

Alfentanil (high) 160 80 * 1

Sufentanil (low) 0.15 0.15 0.003

Sufentanil (high) 0.5 0.5 0.01

Remifentanil (low) 2 0.5-1 * 0.06-0.1

Remifentanil (high) 10 1-2 * 0.3-0.5

*
Give as a rapid infusion over a 1- to 2-minute period.

Table 28-6 -- Manual Infusion Schemes *

Anesthesia Sedation or Analgesia

Drug Maintenance Maintenance

Loading Dose Loading Dose
Infusion Infusion
(µg/kg) (µg/kg)
(µg/kg/min) (µg/kg/min)

Alfentanil 50-150 0.5-3 10-25 0.25-1

Fentanyl 5-15 0.03-0.1 1-3 0.01-0.03

Sufentanil 0.5-5 0.01-0.05 0.1-0.5 0.005-0.01

Remifentanil 0.5-1.0 0.1-0.4 [†]

0.025-0.1

Ketamine 1500-2500 25-75 500-1000 10-20

Propofol 1000-2000 50-150 250-1000 10-50

Midazolam 50-150 0.25-1.5 25-100 0.25-1

Methohexital 1500-2500 50-150 250-1000 10-50

‡
Dexmedetomidine 0.5-1 over 10 min 0.2-0.7

*
After the loading dose, an initially high infusion rate to account for redistribution should be used and
then titrated to the lowest infusion rate that will maintain adequate anesthesia or sedation. When
using opiates as part of a nitrous-narcotic technique or for cardiac anesthesia, the dosing scheme
listed under anesthesia is used. When the opiate is combined as part of balanced anesthesia,
dosing listed for analgesia is needed.