propofol

yoga crna · Dec 10, 2005

I administer propofol every day and find it to be a very unpredicable drug. A very muscular male patient became apneic after a 20 mg test dose. When I tried to ventilate him--he had a laryngospasm and desaturated to 70. If the patient has any cardiac instability or low blood pressure, you may see complications from its use. The fact that it wears off is an advantage, but then you have to know how to administer it, if the patient needs more. I agree with a previous post, it is an induction agent for general anesthesia and has NO ANALGESIC properties.

When used in the ICU on a ventilated patient, it is a different situation, because you don't have to worry about airway issues.

I am constantly amazed that ER personnel are so casual with giving general anesthesia agents such as propofol and ketamine on patients with full stomachs. In anesthesia, they are considered difficult cases requiring rapid sequence intubations.

I have a very close friend who works at the FDA who has informed me that propofol and ketamine will soon have black box restrictions on them not being administered by non-anesthesia personnel, except in ICU settings on ventilated patients. The plaintiff's bar will soon being doing TV ads looking for people who were given these drugs by non-anesthesia people. They will be looking for cases with high liability claims. Check your malpractice insurance.

Final word--if you want to do anesthesia, go to anesthesia school. Only then will you realize how little you knew about these drugs before.

Yoga CRNA

J_W, DNP, APRN, CNS · Dec 10, 2005

I have pushed it before, but only in the presence of the MD that has ordered it. Some of the cardiologists that I have worked with like Diprivan, because of it's short half-life for elective cardioversions...And the MD understands that they have to remain in the room or at least at the nurses station until the patient is awake...I have never had any problems with it...The patients all wake up in less than 5 to 10 minutes...And I have only used it in conjunction with Morphine or Fentanyl or some type of analgesic...

jwk · Dec 10, 2005

I have pushed it before, but only in the presence of the MD that has ordered it. Some of the cardiologists that I have worked with like Diprivan, because of it's short half-life for elective cardioversions...And the MD understands that they have to remain in the room or at least at the nurses station until the patient is awake...I have never had any problems with it...The patients all wake up in less than 5 to 10 minutes...And I have only used it in conjunction with Morphine or Fentanyl or some type of analgesic...

You have described a general anesthetic, not sedation. The fact that you have added MS or fentanyl makes it even more dangerous. Once again you prove the point of all of us who are saying it should only be administered by anesthesia providers.

austin heart, BSN, RN · Dec 10, 2005

Some of these posts are downright scary!!!!!!! It is quite obvious that some of these nurses do not know all the side effects and unpredictablity of this drug. They do not know what they do not know.

austin heart, BSN, RN · Dec 10, 2005

I have pushed it before, but only in the presence of the MD that has ordered it. Some of the cardiologists that I have worked with like Diprivan, because of it's short half-life for elective cardioversions...And the MD understands that they have to remain in the room or at least at the nurses station until the patient is awake...I have never had any problems with it...The patients all wake up in less than 5 to 10 minutes...And I have only used it in conjunction with Morphine or Fentanyl or some type of analgesic...

All I can say is WOW, this is scary.

Danianne · Dec 11, 2005

I agree it is scary. I had propofol as a patient for a Bronchoscopy. I am quite small and the DR. gave me what he thought to be a small dose and I ended up unconcious for three days in ICU. The nurses said that they had NEVER seen that kind of effect before.

MajorDomo · Dec 12, 2005

Please correct me if I am wrong,

a study published in Pediatrics about 6 months ago compared CS meds and Dip was included The study pointed out that it was a good drug for CS in the ER d/t the rapid onset, short half life and its anti-emetic properties. Also in the ERs that I have worked at, MDs are required to be at the bedside during the adminstration of the meds and during the sedation process. In addition, airway equipment must be present during all sedations since anyone sedated has the chance of becoming intubated. Finally, with a ER nurse dedicated to that pt until the pt has a 9 or 10 score, 3 lead, pulse ox, and other equipment, does that not qaulify as a ICU setting for the duration of the procedure?

All medication adminstration is weighing risks vs benefits, no matter if it is Dip, Tequin, Compazine, or Vanc, and all can have poor outcomes but with close monitoring the adverse effects can be quickly seen to.

Just some MN ramblings

MajorDomo

LeahJet, ASN, RN · Dec 12, 2005

CONSCIOUS sedation and Diprivan....isn't that an oxymoron?

...maybe I am over simplifying.....

austin heart, BSN, RN · Dec 12, 2005

I thought every one would like to read this great article on Medscape published a few days ago appropriately titled for this thread ........Propofol Sedation: Who Should Administer?

http://www.medscape.com/viewarticle/518218_print

You do have to join to read the article but I think alot of us are already subscribers. It is free and they have great articles on all sorts of medical stuff. CEUs too.

KatieBell · Dec 12, 2005

Austin

thanks for that documentation. I think I'll print this off and post it anonymously in the break room for thought and comment. I might actually place it in the nurse managers mail box as well for more thought and comment. I am a traveler and they are using Prop for CS- most of the nurses are unaware of the debate going on about using it. They just do whatever the MD says. If someone wants to push proprofol on an unintubated patient- I think they should be aware of the potential problems.

Editorial Team / Admin · Dec 13, 2005

I thought every one would like to read this great article on Medscape published a few days ago appropriately titled for this thread ........Propofol Sedation: Who Should Administer?
http://www.medscape.com/viewarticle/518218_print
You do have to join to read the article but I think alot of us are already subscribers. It is free and they have great articles on all sorts of medical stuff. CEUs too.

Thanks for the article link, austin heart. I was in the process of posting this when I saw your post.

JessicRN · Dec 16, 2005

IV push Propofol can only be given with an anethetist present in our facility in MA. It can be given by drip if the patient is vented.

Do 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.