i love it for sedation on vented patients.
i was an icu nurse (trauma) before i was an er nurse, and we used it frequently on our vented patients -- esp those with closed head injuries, since it tends to lower icps.
i know some ers use it for conscious sedation -- a big no-no where i work (against the nurse practice act -- considered practicing anesthesia). even if it were legal in my state for rns to push it for conscious sedation, i wouldn't be comfortable with it.
as many times as i've given it, and as comfortable as i am with it, it is difficult to predict how someone will react, airway-wise. i've given "just a touch" and knocked out a patient's respiratory drive. not a big deal, since he was on a vent. however, that trait makes it tenuous, at best, for a non-anesthesia provider to use it in a non-intubated patient.
the bad things about using diprivan in a vented pt is 1) the lipid base causes some issues (infection control, triglyceride levels) and 2) hypotension. there are also reports that it causes recipients to have "dreams of a sexual nature about their caregivers"
(one of our pulmonologists quit ordering it for this reason).
the good things are that it is very short-acting, so you can keep your pt sedated and just turn it off when the doc comes by to assess; and the hypoentsion generally responds to a pause in the drip and a little fluid.
there are several threads (many of them quite heated) in either the er forum or the crna forum about the use of diprivan by rns in non-intubated patients that may help you out. many rns are big fans of using the drug for conscious sedation. they seem to think that just because they've never had a problem with it, that they never will have a problem with it. if you ask me, they are counting on the intubation skills of whomever ordered it to bail them out if things go bad.
to me, the bottom line is that the diprivan manufacturer does not support its use in conscious sedation. this means that even if your bon doesn't prohibit rns from using it in non-ventilated patients, you would probably still lose any lawsuit that resulted from a mishap.
i'm glad that my state doesn't let us use it if the patient isn't intubated. it gives me an "easy out," so to speak, when the doc wants to use it. (they can still use it, but they have to push it themselves. same with ketamine, but that is another heated debate around here.)