when doing Q 1H neuro assessments (ie the post-op aneurysm clipping or new closed head injury) do you shut off your propofol every hour and bring the patient up or no? I was told to do so & then was yelled at for doing so. It would seem approppriate to me to do it in such a critical neuro situation, despite the dangers of elevated icp,& hyperdynamic state it produces. Any input is appreciated.

Doris

No, we never woke the patient up like that. You lose your advantage of sedation if you do that. One of the purposes of sedation is to keep that ICP down or to stop the patient from becoming too hypertensive in the post-op period (Yeah! I know, SAH likes lots of BP but you can still have too much) and although constant monitoring of the LOC is highly desirable I, personally have never seen anyone cease sedation, do the obs and then re-start.

Sounds like this work environment needs to sort out some standard protocols.

Thanks Gwenith.

Doris

Our protocol is to interrupt sedation @ 5am and half it, titrating up from that rate if necessary. We do this for stable ICP. If ICP unstable, the physician is notified and protocol is disregarded leaving the pt. sedated.