[nuangel1]

only personnel trained in anesthesia ie crna or anesthesiologist are to give ivp propofol due to the fact its classified as anesthenetic.the only time we rn in my ed can push it or give it gtt is if pt is vented with ett already.

[skipaway]

Originally Posted by S.T.A.C.E.Y

I'm in my final clinical placement in the ER now, and I've seen propofol used several times for concious sedation....though it was always the docs pushing it. What is the controversy around propofol? Is it about the drug itself, or who's pushing it????

The drug is an anesthetic and according to package insert in the Warning section, it states:
"For General Anesthesia or Monitored Anesthesia Care (MAC) sedation, propofol should only be administered by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure."

This implies that propofol should only be given by CRNAs, AAs and Anesthesiologists. Also, the last part implies that ER, GI and other physicians should not be pushing it if they are also involved in the procedure. If there is an airway problem after administering Propofol, and the MD is involved in the procedure, it would be an issue of patient safety.

[Larry77]

We commonly administer propofol but not for concious sedation for maintenence sedation after RSI. For conscious sedation we use one of three methods: Etomidate, Ketamine (usually for peds), or Fentanyl/Versed. Personally I try to talk the docs into Etomidate every time...is my all time favorite drug...such a quick recovery and a smooth procedure (always have RT at bedside )

[BabyJCRNA]

Originally Posted by Larry77

...For conscious sedation we use one of three methods: Etomidate/Succs, Ketamine (usually for peds), or Fentanyl/Versed.

Surely you jest about the first combination of medications for conscious sedation....God help us if you are serious.

[lauralassie]

In ohio we can't give any anesthesia drug IV.

[louloubell1]

Originally Posted by Larry77

We commonly administer propofol but not for concious sedation for maintenence sedation after RSI. For conscious sedation we use one of three methods: Etomidate/Succs, Ketamine (usually for peds), or Fentanyl/Versed. Personally I try to talk the docs into Etomidate every time...is my all time favorite drug...such a quick recovery and a smooth procedure (always have RT at bedside )

The definition of conscious sedation is a pharmacologically induced depressed level of consciousness in which the patient maintains cardiopulmonary stability without externally provided support and in which the patient remains able to respond purposefully to light tactile or verbal stimulation. If you are administering a freakin paralytic (which since you are not a CRNA, I'll clue you in: SUCCINYLCHOLINE IS A PARALYTIC) you really, really need to brush up on drugs appropriate for procedural sedation, and even the basic definition of procedural sedation. That's one of the most ridiculous things I've read in weeks.....

[traumaRUs]

In IL, our nurse practice act is up for renewal this year. One of the biggies is the administration of Propofol for conscious sedation in the ER. Yes, in our ER, RN's could not administer propofol because it was against hospital policy. (Hospital policy can be more restrictive than state law). We also did not give IV Haldol. However, we did give ketamine (always keep the little ones in a dark, quiet room when they wake up - it lessens the nightmares.) It is individual.

This thread points to a very important piece of advice - know your state practice act and your hospital policy.

[Larry77]

LOL...sorry guys didn't mean to stick Succs in there...I guess I shouldn't respond to threads after work when I get home at 0230...

[NicoleRN07]

The only drug we don't push for conscious sedation is Etomidate. I push it for RSI, but when it is used for a conscious sedation, the MD pushes it. Etomidate is awesome for conscious sedation....much less paperwork and time. The doc gives it.....the procedure is completed....the patient wakes up fully......all in 15 minutes tops (if all goes well)

[BamaFlightRN]

Most states have a list of drugs that arent supposed to be administered by the RN. I know here in Alabama there are limitations, particulary with Propofol, Fentanyl, and paralytics. Nurses CANNOT push propofol, we can hang drips on ventilated patients for "ICU sedation". Nurses also cannot administer paralytics to a nonventilated patient..ie RSI...if you have a doubt, check with your board of nursing.