propofol - page 2
do ya'll push it fo concious sedation?... Read More
Nov 29, '05asa files comments on fda propofol petitionasa's letter urges fda to retain the warning label limiting the use of propofol to clinicians trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure.
[color=#990000]asa letter to fda
[color=#990000]attachment 1 - statement on safe use of propofol
[color=#990000]attachment 2 - practice guidelines for sedation and analgesia by non-anesthesiologists
[color=#990000]asa analysis - propofol by non-anesthesiologists (excel file)
submitting comments to fda on propofol labeling
the fda will continue to accept comments until december 27, 2005. you may submit comments either by mail to:
division of dockets management (hfa-305)
food and drug administration
5630 fishers lane, room 1061
rockville, md 20852
be sure to include the docket number 2005p-0267
or submit electronically on the [color=#990000]fda's website.
Nov 29, '05Airway complications and hypoventilation are not the only potentially dangerous side effects of propofol. I prefer versed/ fentanyl for cs. Propofol should be a pure anesthesia agent when used for surgical/ortho interventions.
Long term vented patients on infusions and bis monitoring are a different situation.
Nov 29, '05Also theres always Etomidate. As for Diprovan I have only seen it pushed a couple times and both a CRNA from OR came and did it. It is wonderful for keeping vented patients down however.
Nov 29, '05This is from a patient's point of view, so I'm not an expert. I had propofol for the first time for conscious sedation for a D&C (wasn't offered a narcotic and didn't know to ask). The doctor used a local at the cervix and I didn't experience any pain. I did have some amnesia but was quite uncomfortable in a way that's difficult to explain. I've had the same procedure done a couple of times in the past without a problem. Although propofol avoids that drug hangover, I think narcotics give a better sense of well being. I would definitely not want propofol again for conscious sedation. In fact, the experience was so unpleasant, I would think twice about propofol for anything.
Nov 29, '05We use propofol a great deal for our CS procedures (as well as for our vented pts in ED).
Works great, doctor is at bedside at time of administration, all equipment set up to manage any airway issue (none yet except very infrequent and brief bag/mask ventilation [VERY BRIEF]).
We also can use ketamine (use a lot for kids) and brevital (use a lot with cardioversions) with same caveats as above (MD present and equipment at the ready).
Nov 30, '05Quote from KatieBellHave only used it in drip form for intubated patients. In the states I've worked in it was not in the nurses scope of practice. Don't blame you,would never give it push,but would be willing to be a stand - -by.I'm a traveler and have seen Propofol used for Concious Sedation. I am not fond of this. Usually I prefer Versed, or Ketamine (though ketamine does get squirrley sometimes.)
I actually will not do CS with Propofol. So, at my current facility, when I get a CS patient, if the MD wants to used it, the patient gets another nurse.
Edited to correct where I put Midazolam, instead of Prop. I guess its about time for sleep, just got off my 4th shift in a row of nights LOL.
Nov 30, '05Yes, I'm willing to document or what not, but I am not willing to push it. When I did ICU, used it all the time for sedation, but on vented patients which is a completely different things than needing to put little johnnies elbow back into place.
Of course at one place there was no limit put on the dose of Ketamine and the MD kept telling me to push more and more, so I finally handed him the bottle and the syringe and told him I was uncomfortable with the amt. Surprisingly he agreed and pushed the drug, and the kid did fine. I discussed with the NM and in about 6 days flat there was a new policy with limits....
Sometimes I feel like such a stickler, but I want to keep my license.
Nov 30, '05Quote from teeituptomNow that's an incredible oxymoron - "slightly deeper conscious sedation". Propofol in the hands of non-anesthesia providers, with the exception of ventilated patients in the ICU, is dangerous - period.We are using it more and more for a slightly deeper concious sedation, works wonderously well.
So does Brevitol
Nov 30, '05Quote from austin heartDo a search and there is a great thread with a TON of info on pushing diprovan. I think that it is the GI Nurses section.
From what I understand, pushing Diprovan in bolus form is considered general anesthesia and is out of the scope practice of the RN and requires an anesthesiologist or CRNA, or it is in Texas anyway.
We use it in our GI lab, but only pushed by the anesthesiologist or CRNA. The patients seem to recover faster than with the demerol and versed.
Nov 30, '05Only push it on vented patients, and then hang drip. Loved the stuff when I worked in ICU, now work in ER and try to get vented patients to ICU before needing any "milk of amnesia"
Dec 2, '05I hope most of the participants from the gastroenterology thread do not find this nice little discussion.
According to some, any RN who pushes Dip is guilty of capital murder and threatened with legal action if they discover your name...really ugly stuff.
Open dialogue and open minds looking at SCIENCE BASED EVIDENCE will find the correct answer.
Has anyone ever survived cs with Dip???
Has anyone ever had a "poor pt outcome" with versed, demerol, fentanyl??
Are the main concerns based on pt outcome or who gets reimbursed for pushing the drug??
I don't know the answers to all the ?? but I do know there is an increasing number of docs using it and an increase in the number of pts that ask for it.
Dec 2, '05we use it in ER for conscious sedation for ortho stuff like dislocated hips and elbows. Seen it occassionally for closed reductions wrists and ankles. The docs push it. We keep ambu and intubation equipment set up at bedside but so far have not had to use it. (knock on wood) The patients usually wake up within 5-15 minutes and never even know they were asleep. Otherwise we just use the drip on intubated patients. Sometimes we have to hold them in ER 6-8 hours before an ICU bed becomes available or they can be transferred out.
Dec 2, '05I work in a neuro-trauma unit. We frequently push propofol on vented pts. for procedures, and also for emergent intubations. We'll only push it on non- tubed pts. if the doc is in the unit. Where I worked last, running an infusion over 10mcg/kg/min was considered anesthesia, which we weren't supposed to do. Like THAT was real effective on big pts.!