Background Propofol is a widely used anesthetic and its dose is closely related to aging. Telomere length (TL) is a unique heritable trait, and emerging as a biomarker of aging, health and disease. We proposed a hypothesis that propofol dose can be determined by telomere length, which greatly reduced the risk of anesthesia, especially the elderly.Methods/design To evaluate the association between the propofol dose in anesthesia induction and: TL in the DNA of peripheral blood leukocytes; body weight;sex;difference of the Bispectral Index (BIS) before and after anesthesia induction in patients. To detect deletion at the 5′end or 3′end of telomerase RNA component (TERC). 100 patients scheduled for elective surgery. Multivariable linear regression analyses were undertaken.Results We found that propofol dose in anesthesia induction was clearly correlated significantly with TL (r = 0.78, p <0.001), sex (r = 0.83, p <0.001), body weight (r = 0.84, p = 0.004), and difference of BIS before and after anesthesia induction (r = 0.85, p = 0.029). By comparing the absolute values of standardized regression coefficients (0.58, 0.19, 0.21, and 0.12) of the four variables, it can be seen that TL contributes the most to the propofol dose in anesthesia induction. However, detection of deletion at the 5′ end or 3′ end of TERC was not found, which showed that telomerase in these patients was relatively stable.Discussion These findings provide preliminary evidence that the propofol dose in anesthesia induction was clearly correlated with genetically determined TL. TL may be a promising predictor of the propofol dose, which is beneficial to improve the safety of anesthesia and reduce perioperative complications.