Veterinary Anaesthesia and Analgesia 2022, 49, 243e250 https://doi.org/10.1016/j.vaa.2021.07.

006

RESEARCH PAPER

Determining an optimum propofol infusion rate for

induction of anaesthesia in healthy dogs: a randomized
clinical trial

Kate Waltersa, Kristina Lehnusb, Nai-Chieh Liua & Sarah E Bigbyc

a
The Queen’s Veterinary School Hospital, University of Cambridge, Cambridge, UK
b
Hamilton Specialist Referral Unit 5 Halifax Road, Cressex Business Park, Buckinghamshire, UK
c
Veterinary Specialist Services, Carrara, Queensland, Australia

Correspondence: Kate Walters, The Queen’s Veterinary School Hospital, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK. E-mail:
katelwalters49@gmail.com

Abstract Conclusions and clinical relevance An infusion rate of 1.0

Objective To determine an optimum infusion rate of pro-
pofol that permitted rapid tracheal intubation while mini-
mizing the duration of postinduction apnoea.
Study design Prospective, randomized, blinded clinical trial.
Animals A total of 60 client-owned dogs presented for
elective neutering and radiography.
Methods Dogs were randomly allocated to one of five
groups (groups AeE) to have propofol at an infusion rate
of 0.5, 1, 2, 3, or 4 mg kge1 minutee1, respectively,
following intramuscular premedication with methadone
0.5 mg kge1 and dexmedetomidine 5 mg kge1. Propofol
administration was stopped when adequate conditions for
tracheal intubation were identified. Time to tracheal
intubation and duration of apnoea were recorded. If oxy-
gen haemoglobin saturation decreased to < 90%, manual
ventilation was initiated. A one-way analysis of covariance
was conducted to compare the effect of propofol infusion
rate on duration of apnoea and intubation time whilst
controlling for covariates, followed by post hoc tests. The
significance level was set at p < 0.05.
Results Propofol infusion rate had a significant effect on
duration of apnoea (p ¼ 0.004) and intubation time (p <
0.001) after controlling for bodyweight and sedation
scores, respectively. The adjusted means (± standard error)
of duration of apnoea were significantly shorter in groups
A and B (49 ± 39 and 67 ± 37 seconds, respectively) than
in groups C, D and E (207 ± 34, 192 ± 36 and 196 ± 34
seconds, respectively). Group B (115 ± 10 seconds) had a
significantly shorter intubation time than group A (201 ±
10 seconds, p < 0.001).
mg kge1 minutee1 (group B) appears to offer the optimal
compromise between speed of induction and duration of
postinduction apnoea.
Keywords dog, induction, infusion rate, intubation time,
postinduction apnoea, propofol.
Introduction
Propofol is an alkyl phenol used for rapid induction of general
anaesthesia. A rapid recovery from anaesthesia then occurs
owing to redistribution (Goodman et al. 1987; Morgan &
Legge 1989). It has market authorization for induction of
anaesthesia at 1.0e4.0 mg kge1 in premedicated dogs, or 6.5
mg kge1 in unpremedicated dogs (Morgan & Legge 1989;
Zoetis UK Limited, 2019). The current recommendation in the
datasheet is to administer a calculated dose to effect over
10e40 seconds (Zoetis UK Limited, 2019). In clinical practice,
incremental boluses of propofol are often administered,
although little definitive guidance exists, and administration
techniques differ significantly between clinicians.
The optimum delivery of an induction agent (in terms of
administration technique, rate and dose) should result in rapid
loss of consciousness with no or minimal adverse effects. A time
delay between drug injection and loss of consciousness arises
while the cardiovascular system transports the drug to the brain
where the clinical effect occurs. This delay often results in the
delivered dose exceeding the minimum dose required to achieve
loss of consciousness, as the drug continues to be injected until
an adequate anaesthetic plane is reached (Kazama et al. 2000).
Adverse effects associated with propofol administration are
dose dependent. Postinduction apnoea is the most common

243
 Optimum propofol infusion rate for induction K Walters et al.

adverse event following propofol administration, occurring
with an incidence of 85e100% in studies conducted in
humans and dogs. Apnoea results from a reduction in central
inspiratory drive and ventilatory responses to carbon dioxide
(Goodman et al. 1987; Grounds et al. 1987; Smith et al. 1993;
Muir & Gadawski 1998; Bigby et al. 2017a,b). However,
postinduction apnoea rarely led to cyanosis if dogs were pro-
vided with supplemental oxygen at induction (Smith et al.
1993; McNally et al. 2009). Another adverse effect associ-
ated with propofol administration is decreased mean arterial
blood pressure owing to a reduction in systemic vascular
resistance and a slight decrease in heart rate (HR) (Suarez et al.
2012; Henao-Guerrero & Ricco 2014).
The propofol infusion rate affects the dose required to induce
anaesthesia (Stokes & Hutton 1991; Bigby et al. 2017b), in-
duction time (Rolly et al. 1985; Gillies & Lees 1989; Stokes &
Hutton 1991) and the duration of apnoea (Gillies & Lees 1989;
Bigby et al. 2017b) in humans and animals. In humans, slower
administration was associated with a lower incidence of
apnoea, but longer induction times (Rolly et al. 1985; Gillies &
Lees 1989; Stokes & Hutton 1991). Currently, it is unknown
which infusion rate produces the most favourable combination
of induction speed while minimizing postinduction apnoea by
dose reduction in healthy dogs.
The aim of this study was to determine an optimum infusion
rate of propofol that permitted rapid tracheal intubation while
minimizing the duration of postinduction apnoea in healthy
dogs. We hypothesized that the optimum infusion rate would
lie between the previously described 1 mg kge1 minutee1 and
4 mg kge1 minutee1 (Bigby et al. 2017b; Zoetis UK Limited,
2019).
Materials and methods
Animals
All American Society of Anesthesiologists (ASA) score I dogs
presenting for elective neutering or elective radiography for hip
scoring at the Queen’s Veterinary School Hospital, UK, be-
tween November 2017 and July 2019 were recruited.
Brachycephalic breeds, animals on concurrent medication or

Figure 1 CONSORT (CONsolidated Standards of Reporting Trials 2010) flow diagram outlining the progression of all animals in this randomized
controlled study to identify an optimum propofol infusion rate for the induction of anaesthesia in healthy dogs.

244 © 2021 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights
reserved., 49, 243e250
Optimum propofol infusion rate for induction K Walters et al.

with a history of regurgitation were excluded. Informed owner Intersurgical Inc, NY, USA) to a breathing system delivering
consent was obtained, and the project was approved by the oxygen at 2 L minutee1. The ETT cuff was inflated guided by
University of Cambridge Animal Welfare and Ethical Review pilot balloon palpation. No further manipulation of the animal
Body (AWERB), UK (ref CR 246). was permitted until spontaneous breathing occurred, at which
point an end-tidal carbon dioxide reading was recorded. Once
Study protocol spontaneous breathing occurred, a positive pressure leak test
guided further ETT cuff inflation and isoflurane (IsoFlo; Zoetis)
The progression of all animals included in this study are shown
delivery commenced.
in Fig. 1. Dogs were randomized to one of five groups using a
A second observer, also blinded to the propofol infusion rate,
random number generator (Excel 2010; Microsoft Corporation,
started a stopwatch (Adanac 3000; Marathon, UK) the
WA, USA). Each group was administered a different propofol
moment the syringe driver was activated. They recorded the
infusion rate for induction of anaesthesia: group A, 0.5 mg
time the infusion was stopped, tracheal intubation was ach-
kge1 minutee1; group B, 1.0 mg kge1 minutee1; group C, 2.0
ieved and the first spontaneous breath. The latter was defined
mg kge1 minutee1; group D, 3.0 mg kge1 minutee1; and group
as the first visible chest excursion.
E, 4.0 mg kge1 minutee1. Signalment and planned procedure
Throughout the induction of anaesthesia, HR and respira-
were recorded for each animal. An independent person
tory rates were monitored manually using a stethoscope.
calculated the propofol infusion rate (mL houre1) allocated to
Systolic, mean (MAP) and diastolic arterial blood pressure were
each dog and programmed the rate into the syringe driver
monitored using an oscillometric blood pressure cuff applied to
(Alaris GH; Cardinal Health, Switzerland) before obscuring the
the animal’s pelvic limb distal to the hock (PetMap Graphical
display from view. A total of 6 mg kge1 propofol (10 mg mLe1;
II; Ramsey Medical Inc and CardioCommand Inc., FL, USA). A
Propoflo Plus; Zoetis, UK) was drawn up and set up with an
pulse oximeter probe (Avante Waveline Nano-V2; DRE Vet-
extension set (V-green extension; Vygon, France).
erinary, KY, USA) was placed on the tongue to measure hae-
All animals underwent a physical examination before pre-
moglobin oxygen saturation (SpO2). Recordings were taken
medication with 0.5 mg kge1 methadone (Synthadon; Ani-
before premedication, at the end of preoxygenation (prein-
malcare, UK) and 5 mg kge1 dexmedetomidine (Dexdomitor;
duction), after tracheal intubation and immediately after the
Orion Pharma, UK) by deep intramuscular injection into the
first breath observed after completion of endotracheal intuba-
cervical muscles. An intravenous 22 or 20 gauge cephalic
tion. Animals with SpO2 < 90% received manual ventilation at
cannula (Jelco; Smiths Medical International, UK) with T-
4 breaths minutee1 to a pressure of 12e15 cmH2O until
connector (Bionector T-connector LL; Vygon) was inserted 15
saturation increased to 95% or spontaneous breathing
minutes after premedication. At 30 minutes after premed-
occurred.
ication, each animal was assigned a sedation score between
The total propofol dose administered was calculated by
0 (not sedated) and 21 (profound sedation) by the same
subtracting the residual volume in the syringe and 1.4 mL
observer (KW) familiar with the subjective scoring system
from the extension set, from the original volume drawn up.
assessment tool (Grint et al. 2009; Appendix SA). Oxygen was
The difference in MAP before induction and after tracheal
supplemented via face mask (Face mask clear with diaphragm;
intubation was also calculated. Intubation time was recorded
J.A.K Medical, UK) at 4 L minutee1 for 5 minutes before
as the time taken from starting the infusion to successful
starting the allocated propofol infusion.
tracheal intubation. Duration of apnoea was recorded as the
The same anaesthetist (KW), blinded to the assigned pro-
time from tracheal intubation to the first breath observed
pofol infusion rate, intubated the trachea of all animals using
after completion of endotracheal intubation. For any animals
an endotracheal tube (ETT) (Surgivet; Smiths Medical, UK)
that desaturated and required manual ventilation, duration of
appropriate to the animal’s size. Once the dog was unable to
apnoea was determined as the time taken from tracheal
support its own head and the palpebral reflex and jaw tone
intubation to initiation of manual ventilation; this is included
were absent, the propofol infusion was stopped. If there was no
in subsequent analysis. Any adverse event or intervention
resistance to gentle tongue traction, tracheal intubation was
was recorded.
attempted. In the event of unsuccessful tracheal intubation
(indicated by coughing or resistance to passage of the ETT), the
Statistical analysis
infusion was restarted until tongue retraction was possible and
a second attempt at tracheal intubation was made. Animals A sample size calculation based on a previous study comparing
were excluded from the study if two unsuccessful attempts propofol infusion rate and duration of apnoea (Bigby et al.
occurred. 2017b) was performed. When considering an effect size of
Once the trachea was intubated, the ETT was connected via 0.4 minutes for duration of apnoea, 12 dogs per group would
a capnograph adapter (Clear-therm HMEF with luer port; be required to achieve a power of 80% and an a of 0.05.

© 2021 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights 245
reserved., 49, 243e250

All statistical analyses were performed using the software R
version 4.0.2 for Mac (R Foundation for Statistical Computing,
Austria; http://www.r-project.org). The significance level was
set at p < 0.05. Distribution of data was assessed by Shapiro-
Wilk test for numeric variables within groups. Equality of
variance was tested using Levene’s test. Data are summarized
as mean ± standard deviation for normally distributed data or
median (range) for non-normally distributed data. Either one-
way analyses of variance or Kruskal-Wallis tests followed by
post hoc pairwise comparisons were used to assess differences
among groups in terms of the following variables: age, sedation
score, bodyweight, change in blood pressure and total dose of
propofol.
Outliers [above upper quartile þ 1.5*interquartile range
(IQR) or below lower quartile e 1.5*IQR] were identified for
duration of apnoea and intubation time by group. One-way
analyses of covariance were performed to determine the ef-
fect of propofol infusion rate on duration of apnoea and intu-
bation time after controlling for selected covariates and is
presented as adjusted means ± standard error. Covariates were
selected based on linearity with the dependent variables with p
< 0.05. Post hoc tests were then performed for pairwise com-
parisons among groups with Bonferroni multiple testing
correction.
Results
A total of 62 dogs were enrolled in the study, with a median
age of 22 (8e112) months and a median bodyweight of 11.5
(3e44.3) kg. Prior to induction of anaesthesia, one animal was
withdrawn owing to bradycardia (HR ¼ 27 beats minutee1,
sinus rhythm) following premedication and the dog was given
atipamezole. Another was withdrawn owing to cannula failure
during propofol administration (Fig. 1). Of the 60 animals that
completed the study, 21 presented for ovariohysterectomy, 21
for laparoscopic ovariectomy, and 17 for castration and one for
hip scoring. Each group contained 12 animals, and tracheal
intubation was successful at the first attempt in all animals.
Desaturation (SpO2 values of 84e87%) occurred in three dogs
(5%) in group D requiring manual ventilation at 96, 394 and
404 seconds after tracheal intubation, respectively.
The mean dose of propofol, duration of apnoea and intuba-
tion time were significantly different among groups (p < 0.001,
p ¼ 0.017 and p < 0.001, respectively), whereas age, body-
weight, sedation score and blood pressure difference were not
(p ¼ 0.697, p ¼ 0.722, p ¼ 0.956, and p ¼ 0.456, respec-
tively). Distribution of results for duration of apnoea and
intubation time are shown in Fig. 2. There were six outliers
identified: three in group A, two in group B and one in group D.
The total dose of propofol administered to induce anaes-
thesia was significantly less in group B (2.1 ± 0.5 mg kge1)
than in groups C (3.4 ± 0.9 mg kge1; p ¼ 0.037), D (3.8 ± 0.8
246 © 2021 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights
Optimum propofol infusion rate for induction K Walters et al.
Figure 2 Box and whisker plots showing the distribution of duration
of apnoea and time to tracheal intubation for five different propofol
infusion rates used for the induction of anaesthesia in 60 healthy dogs
following intramuscular premedication with methadone 0.5 mg kge1
and dexmedetomidine 5 mg kge1. There were 12 dogs per group:
group A, propofol infusion rate 0.5 mg kge1 minutee1; group B, 1 mg
kge1 minutee1; group C, 2 mg kge1 minutee1; group D, 3 mg kge1
minutee1; group E, 4 mg kge1 minutee1. The whiskers demonstrate
the range; the boxes show the interquartile range; the line in the box
is the median. Outliers are marked as dots. Significance is set at p <
0.05. *Significantly different from groups CeE. ySignificantly different
from groups BeE.
mg kge1; p ¼ 0.003) and E (3.9 ± 1.3 mg kge1; p ¼ 0.004),
with no significant difference from group A (1.6 ± 0.8 mg
kge1; p ¼ 0.917).
Bodyweight (p ¼ 0.034) and sedation score (p ¼ 0.026)
were identified as covariates for duration of apnoea and
intubation time, respectively. Propofol infusion rate had sig-
nificant effects on duration of apnoea [F (4,48) ¼ 4.403, p ¼
0.004] and intubation time [F (4,48) ¼ 23.103, p < 0.001]
after controlling for body weight and sedation score, respec-
tively. Subsequent post hoc pairwise comparisons between the
adjusted means identified that groups A and B had a signifi-
cantly shorter duration of apnoea than groups CeE, with no
significant difference between groups A and B (Table 1).
Intubation time was significantly shorter in group B than in
group A, with no significant difference in groups CeE
(Table 2).
Discussion
A propofol infusion rate of 1.0 mg kge1 minutee1 is optimal for
the induction of general anaesthesia in healthy dogs sedated
with methadone and dexmedetomidine. Both 0.5 and 1.0 mg
kge1 minutee1 rates were associated with significantly
reduced propofol induction doses and shorter postinduction
reserved., 49, 243e250
Optimum propofol infusion rate for induction K Walters et al.
Table 1 Pairwise comparisons of duration of apnoea between five different propofol infusion rates. A total of 60 dogs were included, 12 in each
group. A one-way analysis of covariance was conducted with bodyweight identified as a covariate and is presented as adjusted mean ±
standard error. The significance identified by post hoc pairwise comparisons with Bonferroni multiple testing correction between groups are
shown. Propofol infusion rate: group A, 0.5 mg kge1 minutee1; group B, 1 mg kge1 minutee1; group C, 2 mg kge1 minutee1; group D, 3 mg
kge1 minutee1; group E, 4 mg kge1 minutee1
Group Duration of apnoea (seconds)
A 49 ± 39
B 67 ± 37
C 207 ± 34
D 192 ± 36
E 196 ± 34
*
Significance level was set at p < 0.05.
apnoea than higher rates. However, 1 mg kge1 minutee1
resulted in a significantly shorter time to tracheal intubation
than 0.5 mg kge1 minutee1.
Shorter tracheal intubation times were achieved with faster
infusion rates in the present study, although no statistical
difference was found between 1 mg kge1 minutee1 and higher
rates. There appears, therefore, to be no benefit in adminis-
tering propofol infusions at a rate greater than 1.0 mg kge1
minutee1 to hasten tracheal intubation in healthy animals.
The more rapid onset of clinical effects can be explained by
higher infusion rates more rapidly achieving greater concen-
tration gradients between the arterial blood and the central
nervous system (CNS) than slower infusion rates (Stokes &
Hutton 1991). However, there is also a positive association
between the infusion rate and total propofol dose administered.
In the present study, for the 1.0 and 4.0 mg kge1 minutee1
infusion rates, the total doses administered mirror those re-
ported by Bigby et al. (2017b) (1.8 ± 0.6 and 4.1 ± 0.7 mg
kge1, respectively). The association between higher infusion
rates and larger propofol doses suggests that the transfer of
drug to the effect site (CNS) is not solely dependent on drug
concentration gradients, but also on rate-limiting kinetics
described as the ‘biophase delay’ (Stokes & Hutton 1991;
Larrson & Wahlstrom 1994). The biophase delay arises as a
result of a set transport time limiting the uptake to the effect
site, permitting even slow infusion rates of propofol to achieve a
sufficient and sustained concentration gradient. In addition,
the effect site concentration for the clinical measures of drug
effect is independent of the rate of increase of the effect site
concentration (Doufas et al. 2004). Therefore, faster propofol
infusion rates result in plasma accumulation and a relative
overdose, prior to the onset of clinical signs.
The present study mirrors findings in humans and dogs,
where slower propofol infusion rates were associated with
reduced incidences and durations of postinduction apnoea
(Rolly et al. 1985; Goodman et al. 1987; Gillies & Lees 1989;
Berthoud et al. 1993; Bigby et al. 2017b).
© 2021 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights
reserved., 49, 243e250
Group (p)
A B C D E
e 0.732 0.004* 0.010* 0.007*
e e 0.008* 0.020* 0.015*
e e e 0.760 0.808
e e e e 0.946
e e e e e
This probably occurs as slow infusion rates are less likely to
overshoot the dose required, and therefore cause fewer dose-
dependent adverse effects (Stokes & Hutton 1991; Ludbrook
& Upton 1997; Ludbrook et al. 1998). The duration of post-
induction apnoea reported by Bigby et al. (2017b) was shorter
for 1.0 mg kge1 minutee1 and longer for 4.0 mg kge1
minutee1 (10 ± 18 and 287 ± 125 seconds, respectively) than
in the present study. This could be related to individual
anaesthetist variability, timing of tracheal intubation and
study design, such as criteria dictating when the propofol
infusion should cease. In the present study, the propofol infu-
sion was stopped when the plane of anaesthesia was deemed
adequate for tracheal intubation, while in the study reported
by Bigby et al. (2017b) the infusion was continued until suc-
cessful tracheal intubation was achieved. The decision to alter
the protocol was taken to reflect clinical practice.
Covariance was identified between duration of apnoea and
bodyweight, as well as intubation time and sedation score.
Although no significant difference was identified between
groups, there was variation within each group for these vari-
ables. In addition, although infusion rates are calculated based
on bodyweight, physiological processes including metabolic
rate and drug metabolism are more closely correlated to body
surface area (El Edelbi et al. 2012; Nam et al. 2017). This may
account for the covariance identified in the present study.
The effect of propofol on blood pressure was minimal and not
significantly different between groups. Significant decreases in
arterial blood pressure and systemic vascular resistance have
been reported in humans and veterinary species following
propofol administration (Fairfield et al. 1991; Hug et al. 1993;
Smith et al. 1993; Zheng et al. 1998; Suarez et al. 2012;
Henao-Guerrero & Ricco 2014; de Wit et al. 2016; Cattai et al.
2018). In sheep, Zheng et al. (1998) identified a correlation
between propofol plasma concentration and the magnitude of
blood pressure decline, with the greatest reduction seen in
cases receiving propofol at high injection speeds. Similarly, in
acepromazine-premedicated dogs, Cattai et al. (2018)
247
 Optimum propofol infusion rate for induction K Walters et al.
Table 2 Pairwise comparisons of intubation time between different propofol infusion rates. A total of 60 dogs were included, with 12 per
group. A one-way analysis of covariance was conducted with sedation score identified as a covariate and is presented as adjusted mean ±
standard error. The significance identified by post hoc pairwise comparisons with Bonferroni multiple testing correction between groups are
shown. Propofol infusion rate: group A, 0.5 mg kge1 minutee1; group B, 1 mg kge1 minutee1; group C, 2 mg kge1 minutee1; group D, 3 mg
kge1 minutee1; group E, 4 mg kge1 minutee1

Group (p)

Group Intubation time (seconds) A B C D E

A 201 ± 10 e < 0.0001* < 0.0001* < 0.0001* < 0.0001*
B 115 ± 10 e e 0.913 0.113 0.055
C 113 ± 9 e e e 0.121 0.053
D 93 ± 9 e e e e 0.204
E 76 ± 9 e e e e e

*
Significance level was set at p < 0.05.

identified maximal cardiovascular depression 50e60 seconds
after propofol administration, with the magnitude related to
propofol plasma concentration. The fact that these effects were
not observed in the present study could be explained by the use
of lower infusion rates than the 10 mg kge1 minutee1 reported
by Cattai et al. (2018). Furthermore, we did not administer
acepromazine, which may exacerbate hypotension by
contributing to vasodilation (Smith et al. 1993; Maddison et al.
2008). In addition, dexmedetomidine-mediated vasoconstric-
tion may have helped to maintain vascular tone in animals in
the present study (Robinson et al. 1997; Ohata et al. 1999).
Effects of rate of administration on blood pressure may be more
readily elucidated if potent vasoconstrictors such as a2-adre-
noceptor agonist drugs are not used prior to administration of
propofol.
In the present study, the mean duration of apnoea in dogs
given 0.5 and 1.0 mg kge1 minutee1 propofol infusion rates
was shorter than desaturation times (69.6 ± 10.6 seconds for
dogs breathing room air and 297.8 ± 42.0 seconds for dogs
receiving oxygen supplementation) reported by McNally et al.
(2009). This suggests that slower infusion rates would be
particularly beneficial in animals that do not tolerate preox-
ygenation. In the present study, three animals desaturated and
required manual ventilation despite preoxygenation. All three
animals received high doses of propofol at faster infusion rates.
Desaturation occurred early after induction in one dog, and
this may be linked to a sampling error, such as compression of
lingual vessels or ambient light interference; while two dogs
developed prolonged postinduction apnoea and probably
desaturated owing to hypoventilation.
The present study has several limitations. The setup using a
T-connector as a cannula attachment was a limitation.
Although the T-connector has a volume of 0.3 mL, this addi-
tional volume introduced a delay between starting the infusion
and the drug reaching the animal. This is most relevant in
smaller animals at slower infusion speeds. However, as there
was no difference in weight among groups, the impact on the
data should have been minimal. In future, the connector could
be primed with propofol in addition to the extension line, or the
timer only started when propofol visibly reached the animal.
Another limitation was the use of subjectively defined time
points guiding decisions about when to stop propofol admin-
istration or determine what constituted a first breath. The first
breath was recorded as the first visible chest excursion. During
the study, it became apparent not all animals continued to
breathe once the first chest excursion had occurred, while
others initially breathed very shallowly. However, as the same
blinded observers determined what constituted the first breath
and decided when the infusion should stop, the impact of
subjective decisions was minimized. Another limitation of the
study design was the inclusion of animals requiring ventilation
following desaturation. If this intervention had not been initi-
ated, apnoea would have continued in these three animals.
Therefore, duration of apnoea would have been longer in their
respective groups if no intervention was made. Finally, physi-
ological monitoring was noninvasive relying on oscillometric
blood pressure and SpO2 rather than direct arterial pressure
measurements or blood gas sampling. This type of monitoring
was most relevant to daily clinical practice for ASA I animals
undergoing neutering and imaging procedures.
In conclusion, a 1.0 mg kge1 minutee1 infusion rate offers
the best compromise between speed of induction and duration
of postinduction apnoea in healthy dogs. Differences in the
distribution pharmacokinetics between propofol infusions
and boluses are reported (Stokes & Hutton 1991). Therefore,
further studies should compare the optimum infusion rate
(1.0 mg kge1 minutee1) we identified with incremental low
dose (1e1.5 mg kge1) bolus administration of propofol to
facilitate tracheal intubation. This may identify whether the
optimal induction dose of propofol is less using bolus admin-
istration as compared with the slow continuous administra-
tion used in this study.

248 © 2021 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights
reserved., 49, 243e250
Optimum propofol infusion rate for induction K Walters et al.
Acknowledgements
Thank you to Jennifer E. Carter, University of Melbourne,
Australia, for the original concept. This research did not
receive any specific grant from funding agencies in the public,
commercial or not-for-profit sectors.
Authors’ contributions
KW: data collection, statistical analysis and interpretation of
the data, manuscript preparation. KL: experimental design,
data collection, manuscript preparation. NCL: statistical anal-
ysis and interpretation of the data, manuscript preparation.
SEB: experimental design and manuscript preparation.
Conflict of interest statement
The authors declare no conflict of interest
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