[New CCU RN]

well to repost on this too.... our docs now are trying to stear away from sedation while pts are intubated bc of some study?? anyone heard of it that i guess says that nonsedated pts are extubated quicker than sedated ones...

i havent gotten my hands on this study yet...

i just know it is making for wild times in our ccu (not to mention pts in a lot of pain)

[heartrn716]

diprivan is used in my facility for short term uses, at the higher end of the dosing it is a paralytic,(100-150mcg/kg/min) thus the reason it is used in the OR by anesthesia. We have used it on etoh'ers but, the drug of choice for them is a benzo. Also many etoh'ers have cirrohisis and the lipid content of the diprivan is only going to further compromise their liver function. We have also used diprivan for pts being detoxed in general, we seem to be doing alot of the drug abusers who get themselves into life threatening situations. vent 'em sedate 'em and keep 'em down, waking them up only when absolutely necessary. since their pain tolerance is very low, for the most part, and dependency is high on substances this works out well. Again, since it is very expensive and it is a lipid it should be looked at carefully.

[Gardengal]

Frequently we reach fo rpropofol because it works so fast and wears off so quickly, but sometimes we end up on really high doses pretty rapidly.

Typically we don't like to go higher than a max of 85mcg/kg/min (5mg/kg/hr)because of the risk of propofol infusion syndrome which has been seen at doses at that level and above. As our doses increase we add benzos like Ativan or narcotics (morphine or fentanyl) to add analgesia and potentiate the action...thus using less propofol.

There have been a few publications speaking to propofol infusion syndrome which describe: resistant to treat bradycardia, severe metabolic acidosis, lipemia, enlarged liver and rhabdomyolosis. This is well known with children, but also discussed with adults.
2 journal articles you might want to look for:

Cremer et al.., Lancet 2001;357:117-8
and Kang , Ann Pharmacother 2002;36:1453-6

Darn shame about these dosage limits we now shoot for. More work, but less risky for our patients. Our patients are sometime really tough to sedate and keep safe with sedation...now that we know more potential side effects we have to add other agents to keep dosages lower.

[mattsmom81]

Originally posted by New CCU RN
steal diprivan...geez... we got better stuff than that to steal...hha ...just kidding

Actually a nurse in one facility I work with was caught injecting herself with Diprivan in the bathroom....had several bottles in her bag.

We weren't signing Diprivan out before this incident...now we are.

[KR]

Hi all! While it is nurses judgement in the MICU where I work at on how high we go up on the diprovan, our intensivists generally do not like us going above the 75-80 mcg/kg/min range. They have showed us the literature that prolonged high does of diprovan can cause V-tach. Just a point to ponder.

[Patricia116]

Originally posted by Estella
Hi!
We have a nutritionist and pharmacist working together on a daily basis to keep the lipid levels r/t diprivan and TPN usage. When tube feeds start, they reevaluate the lipids there, too, just to be sure the pt isn't getting way too much fat. (We get a lot of gastric bypass pts. The last thing they need is a large fat intake. Their TPN is usually without lipids.)

Another point to remember when using Diprivan with an obese patient, to avoid excessive dosing, the patient's ideal weight should be used to adjust dosage according to the manufacturer of Propofol.

[jadednurse]

Originally posted by New CCU RN
well to repost on this too.... our docs now are trying to stear away from sedation while pts are intubated bc of some study?? anyone heard of it that i guess says that nonsedated pts are extubated quicker than sedated ones...

i havent gotten my hands on this study yet...

i just know it is making for wild times in our ccu (not to mention pts in a lot of pain)

I cringe when I hear things like this. I wonder how many of these docs have ever been intubated!

Good thread, informative posts. I've found that the dosing of Diprivan really varies w/ the climate you work in, and the knowledge base of the doctors who are writing for it.

Getting back to your original post...what the heck good is it to continue any sedation if IT"S NOT WORKING? First, they need to make sure the patient is being treated for pain (as one post pointed out, Dirprivan is used for sedation, NOT analgesia!). Second, they may need to use a combination of drugs or find a different one entirely. Diprivan is costly, especially if it's not working!

[New CCU RN]

Well, the rationale behind the study was that those patients that were heavily sedated had a longer time to be extubated. While I agree that you need to treat pain, I can understand keeping a patient awake but treating the pain, rather than completely snowed. Vent acquired pneumonia, sepsis, and ARDS secondary to prolonged intubation times are alot worse.

[jeannet83]

In our ED and trauma bay, we use propofol gtts as well for sedation. I find the healthy young guys really tear it up fast more so than the elderly. We also use small boluses of Propofol for conscious sedation of awake and non-intubated patients who need fractures aligned or dislocations put back in place. Works like a charm!

We are not allowed to use Droperidol anymore secondary to its history of cardiac effects. Are other people still using Droperidol?

Jeanne

[RNCENCCRNNREMTP]

Originally posted by jeannet83

We are not allowed to use Droperidol anymore secondary to its history of cardiac effects. Are other people still using Droperidol?

Jeanne

Ever since droperidol got "black labeled" for its association with Torsades we have not used 1 drop!!!!