Age-related differences in propofol dosing for procedural sedation in the emergency department

Background: Propofol dose requirements may differ in the elderly due to age-related changes in pharmacokinetic or pharmacodynamic variables. Objective: The objective of this study was to determine the effect of patient age on propofol dose required for procedural sedation in the Emergency Department (ED). Methods: This was a retrospective cohort study conducted in a tertiary hospital ED. Adult patients who underwent procedural sedation in the ED using propofol were grouped a priori by age into three categories: 18-40 years, 41-64 years, and ≥65 years. The median induction dose and total dose of propofol required for the procedure was compared between the three age group categories. Multivariate linear regression analyses were used to adjust for confounders. Results: A total of 170 patients were included in the final analyses: 18-40 years (n = 66), 41-64 years (n = 59), and ≥65 years (n = 45). The median induction dose was 1.4, 1, and 0.9 mg/kg, respectively; and the median total propofol dose was 2, 1.7, and 1.2 mg/kg, respectively. The ≥65 year-old group required significantly less propofol (mg/kg) for induction (compared to the 18-40-year-old group) and for the entire procedure (compared to all other groups) (p < 0.001). In the multivariate linear regression analyses, patient age was negatively predictive of induction dose (coefficient -0.011, 95% confidence interval [CI] -0.017 to -0.005) and total dose (coefficient -0.014, 95% CI -0.022-0.007) after adjusting for confounders. Conclusion: Elderly patients may require lower doses of propofol for procedural sedation in the ED, compared to younger adults.