[BethAn]

That sounds about right. MICU=highest acuity and lowest amount of revenue for the hospital. Always trying to save a buck.

[*AlexRN*]

I have a question about propofol ... it is a sedative... so it does nothing for pain, correct?

I ask this because I had a patient on a ventilator (I'm still a student) that required neuro checks... you could tell he was in pain because they had to put this corset on him...30 minutes after they put it on, he was restless, and his bp, HR went up, along with respirations...he just looked like he was in PAIN... he had morphine PRN, but they called the doc and started him on a propofol... and by the way my instructor put it, it does nothing for pain, but he's just too sedated to show it.

I don't understand why they didn't just use the morphine? We ended up slightly loosening the corset, and that helped a little bit.

[cardiacRN2006]

What a shame that they didn't give him the PRN morphine. What was he on for sedation prior to the propofol being started?

[Ophelia78]

You are correct, Propofol is a sedative/hypnotic only- it does not provide pain relief. Patients who are sedated should be closely monitored for nonverbal signs of pain, since they will most likely be unable to communicate that they are having it. It is the policy at our hospital that patients receiving continuous sedation also receive a fentanyl or morphine drip for continuous analgesia.

Most of our vented patients start out on a Propofol drip, but our policy only allows for 48 hours. After that, everyone is switched to an Ativan drip. Our PharmD gives the reasoning for this as the risk for increased triglycerides and Propofol Infusion Syndrome, though quite frankly, at the last ICU I worked at we used Propofol for longer than 48 hours and I never heard of anyone developing that syndrome...

[suanna]

We use Propofol frequently for our post-op patients that wake up a little wild on the vent. The best property is that unlike narcotic or benzo. sedation you can frequently wean the vent to near extubation settings without cutting off all sedation. One problen for longer use (at least in my experience) is tolerance developes quickly requiring increasing doses as the days go by.Also beware the "diprovan drools"- vastly increased oral secreations with a diminished cough This is just asking for a pneumonia- frequent mouth care & suctioning [good nursing care] helps solve this problem.

[dfk]

propofol has an initial T1/2 of about 40 minutes, but also has a terminal T1/2 of anywhere from 4 hours to roughly 3 days.. it hangs out in adipose tissue, so prolonged sedation can actually occur. also, a previous post commented on using lidocaine in the bottle.. it is not labeled as such a use, but can be done... not that i'm promoting it ! ... also, propofol has mild anti-emetic properties.. now, that is one nice drug

[pebbles]

We use propofol in our ICU.

Almost always it is in combination with other drugs - analgesic and also a longer-acting sedative. We commonly run fentanyl and midazolam infusions as well. That way, we don't have to (usually) use such large doses of any one drug.

Propofol is great because it is so short acting. You turn it off, wait a few mins, do a thorough assessment of the neuro status, and then turn it back on.

A known side effect is apparently erotic dreams..... (one of my ICU course instructors confirmed this!!)

[meandragonbrett]

Originally Posted by Ophelia78

Our PharmD gives the reasoning for this as the risk for increased triglycerides and Propofol Infusion Syndrome, though quite frankly, at the last ICU I worked at we used Propofol for longer than 48 hours and I never heard of anyone developing that syndrome...

While the increased triglycerides and propofol infusion snydrome are real concerns, it is not as common as many think.


Also, there was no reason not to be giving the PRN narcotics to this patient.

[Bonnie Nurse]

Downside of using propofol long-term is an increase in chance of patient's developing pancreatitis, I believe, due to the lipids in the drug.

[criticalHP]

We use propofol for our vented patients, although I have to say I don't always see additional infusions of analgesics concurrently ( less than 50%)unless the patient was trauma, surgical, or hx of chronic pain. Usually a PRN order for morph. or fent. is given, but non-verbal pain measurements are subjective, and I feel patients in my unit are being under treated for pain. I've brought this up at our UBC and to the intensivists but so far no changes. I try to impart this point on newbies that I precept anyway to break the chain of bad habit.
As far as names.I've heard...propofol=diprivan=milk of amnesia=mothers' milk