Cosmetic Surgery Death after RN (not CRNA) Administered Propofol - page 3

As usual, it took a patient death to effect change to a dangerous practice. This is why I, an operating room nurse, am so adament about getting the practice of RNs giving conscious sedation stopped,... Read More

  1. by   miloisstinky
    I just read an article regarding the safety of RN's administering propofol for conscious sedation. But why the heck would you risk your license without the proper training or licensing to back you up, ive heard of RN's refusing to do this, and now that i am in a nurse anesthesia program....it scares the hell out of me about how little i knew about managing an airway. :uhoh21:
  2. by   rn29306
    You wanna see the absence of intelligence concerning propofol usage?
    There is a thread under the GI and Emergency nursing specialties regarding propofol that perhaps everyone here should read. Some of the posts are actually quite hilarious in nature.

    The infamous, 16 page, 14,000+ hit GI Propofol debate:
    http://allnurses.com/forums/f21/propofol-13194.html

    ER thread:
    http://allnurses.com/forums/f18/propofol-130833.html
    Last edit by rn29306 on Jan 29, '06
  3. by   SigmaSRNA
    Quote from miloisstinky
    I just read an article regarding the safety of RN's administering propofol for conscious sedation. But why the heck would you risk your license without the proper training or licensing to back you up, ive heard of RN's refusing to do this, and now that i am in a nurse anesthesia program....it scares the hell out of me about how little i knew about managing an airway. :uhoh21:
    I second that emotion!!!!
  4. by   NurseasPatient
    Quote from rn29306
    You wanna see the absence of intelligence concerning propofol usage?
    There is a thread under the GI and Emergency nursing specialties regarding propofol that perhaps everyone here should read. Some of the posts are actually quite hilarious in nature.

    The infamous, 16 page, 14,000+ hit GI Propofol debate:
    http://allnurses.com/forums/f21/propofol-13194.html

    ER thread:
    http://allnurses.com/forums/f18/propofol-130833.html
    Good grief! There are some real derilects administering this very potent med! I just read some of their posts! I always tried as a nurse to never work out of the scope of my training. Why in the "L" would anyone want to administer something they are not completely trained & licensed to use?! I have to wonder if they have ever heard the phrase "first do no harm"?? I hope at least a few of these "heroes of resuscitation" pull their head out of their behinds before they kill somebody! (please excuse if I have misspelled anything- another symptom of this mess I have- never used to have probs. writing- drives me nuts)!
  5. by   deepz
    http://www.eplabdigest.com/article/5899


    The authors assert:

    "Propofol, a central nervous system depressor classified as a deep
    sedation medication with a very short half-life........"

    I wonder where they found that description? Not on the manufacturer's
    prescribing info which clearly classes propofol as an *anesthetic*
    agent, for use by trained anesthesia personnel only.

    That's 'science' all right, right up there with Silber et al. in the annals of research infamy.


    .
  6. by   UCDSICURN
    Quote from deepz
    http://www.eplabdigest.com/article/5899


    The authors assert:

    "Propofol, a central nervous system depressor classified as a deep
    sedation medication with a very short half-life........"

    I wonder where they found that description? Not on the manufacturer's
    prescribing info which clearly classes propofol as an *anesthetic*
    agent, for use by trained anesthesia personnel only.

    That's 'science' all right, right up there with Silber et al. in the annals of research infamy.


    .
    I guess JAMA and The New England Journal of Medicine chose not to publish this garbage either....the Rhythmn Society though...i missed that one...guess i have to wait for next year....
  7. by   jwk
    Quote from deepz
    http://www.eplabdigest.com/article/5899


    The authors assert:

    "Propofol, a central nervous system depressor classified as a deep
    sedation medication with a very short half-life........"

    I wonder where they found that description? Not on the manufacturer's
    prescribing info which clearly classes propofol as an *anesthetic*
    agent, for use by trained anesthesia personnel only.

    That's 'science' all right, right up there with Silber et al. in the annals of research infamy.


    .
    Here's my favorite quote from the article:


    "The level of sedation used in our lab renders the patient completely unconscious"

    That is a general anesthetic by any definition. Seems like they are in violation of JCAHO standards, and probably Michigan state law if they have a non-anesthesia RN administering the propofol in this situation.
  8. by   sbuxdrinkr
    To take it a step below propofol, we routinely use Versed for conscious sedation and at times the patient does become apneic. IMO the provider administering anything that can potentiate respiratory compromise should be highly skilled in airway management. It is an unacceptable risk for anyone not trained in ET intubation to be using induction agents/sedatives that can cause apnea without direct supervision from a skilled clinician.
  9. by   jwk
    Quote from sbuxdrinkr
    To take it a step below propofol, we routinely use Versed for conscious sedation and at times the patient does become apneic. IMO the provider administering anything that can potentiate respiratory compromise should be highly skilled in airway management. It is an unacceptable risk for anyone not trained in ET intubation to be using induction agents/sedatives that can cause apnea without direct supervision from a skilled clinician.
    Versed to the point of apnea is NOT conscious sedation.
  10. by   sbuxdrinkr
    agreed. but, when dealing with potent benzo's and hypnotics one must understand that each pt will react differently and the provider must be prepared to manage the airway appropriately and administer a reversal agent if appropriate. (not that one sets out to make the pt apneic, but at times it does happen) there are many documented cases of people dying in dental offices from what was supposed to be conscious sedation and turned into full blown anesthesia, if you will.
  11. by   jwk
    Quote from sbuxdrinkr
    agreed. but, when dealing with potent benzo's and hypnotics one must understand that each pt will react differently and the provider must be prepared to manage the airway appropriately and administer a reversal agent if appropriate. (not that one sets out to make the pt apneic, but at times it does happen) there are many documented cases of people dying in dental offices from what was supposed to be conscious sedation and turned into full blown anesthesia, if you will.
    Conscious sedation that progresses to general anesthesia is almost always due to either impatience, incompetence, stupidity, or some combination thereof. It just shouldn't be happening. Use of flumazenil or narcan in our hospital (except in the OR) means an incident report gets filed and reviewed.

    It's a very rare thing that a patient becomes apneic from midazolam in appropriate doses. When it does happen, it's often because the operating physician is impatient and demands more drugs, when the first dose hasn't even had time to circulate and have an effect. 1mg becomes 2 which becomes 3, 4, and 5, and then you wonder why your 90 year old patient for an EGD isn't breathing. If this kind of thing happens in your facility with any kind of frequency at all, you need to closely re-examine your procedures and the ordering physicians (or nurses that blindly follow those orders) need to be re-trained.
  12. by   smileyRn96
    This is an old thread, but interesting....we do not call it conscious sedation anymore, we call Moderate sedation....I used moderate sedation a lot in the ED for dislocated shoulders, hips, ankle, and to reduce hernias as well...We used Etomidate mostly in the ED, the patients are on monitor, ambu-bag at bedside, code cart within reach, on o2, suctions ready, iv access with saline bag hanging and ready to bolus if needed, and 1:1 nurse ratio until fully awake post procedure...I never had any real issues to speak of except maybe one time that we gave like 3 ambu breaths to a patient when their sat dropped to 88% and then they began to wake up...We did it all the time, but it was never done without adequate preperation and it was taken very seriously.
    Now in my Icu, people love versed and fentanyl. Also, that is all I see endo use and they always look a little nervous.
    Propofol to an unitubated pt in MRI????? To me that sounds crazy.
    -Smiley
  13. by   GmanRN
    I posted a thread that lightly touches on the topic of RNs providing procedural conscious sedation. It hasnt been approved by the mods as of now, but it has the word "HALO" in the title.

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