Expert: Ronald Levy, M.D. - 6/5/2008

Question
Hello Dr. Levy,

Thank you in advance for helping people and for sharing your medical expertise and knowledge.

For a patient premedicated with Buprenex (0.01mg/kg), what is the safe range of Propofol dose for "induction anesthesia" (not maintenance anesthesia)?   

I would like to research and read more about the drug interactions of Buprenex and Propofol, can you please suggest medical textbooks or journals for me to continue my research?

Many thanks again.  

Answer
Your question is a difficult one to answer because there is no direct answer. While we give most drugs based on weight, we always titrate to effect. A person on chronic Buprenex will have developed some tolerance to its effects and while we always use a reduced dose of Propofol in patients on narcotics, there is no specific number. When I induce a patient, I always titrate to effect. So if the usual dose is 150 mg, I might start with 120mg to see if that is enough. I always go by the maxim, "I can always give more, I can't take away!" As for researching, again there is no source that will compare the two specifically. There are numerous sources on each drug individually. Be careful if you are using online sources and they may not be "peer-reviewed" and so the comments on them may not be accurate.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston