[cmo421]

Originally Posted by neurogeek

One of the problems associated with propofol use is the result of not providing "drug holidays" as should be done daily. All patients receiving any long-term sedation should receive drug holidays. It's always amazed me how nurses can say they evaluated the neuro status of patients yet never lifted them from the sedation. This just isn't possible. I lift my patients every single hour when I perform my neuro assess, unless there is contra-indication such as status, or extreme increases in ICP, etc.

Where I have worked, we woke pt's up q1-2hrs. Unless it was really hard to get them down, then it was q3-4 and when the doc's rounded. I always wake a real bad head in between turns after the ICP calms. I still love the Dipi! One of the best drugs I have seen work especially in young trauma pts who might have been intoxicated or under drug influence prior to the accident. Better then knocking them down with Ativan and /or heavy Narcotics and then having a hard time checking their neuro status.

[Christie RN2006]

The only side effect that I have seen so far from Diprivan is that it turns their urine a funny greenish color.

Diprivan is the drug of choice with most of our patients, but we are starting to use more Ativan drips now that we have intensivists.

I had a patient one time completely maxed on Diprivan and so we had to start him on an Ativan drip too!! I had him up to 2mg Ativan/hr and 50-60mcg of Diprivan/hr just to keep him from jumping out of the bed!! When we was admitted he was drunk and high on several different drugs and it was when he started going through detox that we had to super sedate him like that.

[NeuroICURN]

Originally Posted by nrsang97

Had a pt yesterday who was taken off propofol, due to propofol induced pancreatitis, and green urine (a ugly green too). Pt was having issues with DIC also. BUT this was the only thing that worked to decrease her ICP. After d/c the drip her ICP was in the 30-40 range all day with paramaters to keep less than 30. Versed and Fentanyl gtt's didn't work, mannitol didn't work either. I have today off so I have no idea what they did for her. So I can see why the drug is only for short term sedation.

Did they try 3% NaCl? A bolus (typically 2-4 mL/kg) and then start a gtt??

[nrsang97]

Originally Posted by NeuroICURN

Did they try 3% NaCl? A bolus (typically 2-4 mL/kg) and then start a gtt??

I posted this almost a year ago. The pt didn't get a 3% bolus since we only started using it recently. The pt did receive mannitol, and 23% nacl , ivp. I do remember that this pt passed away, a few days after I posted the original post.

We now use 3% boluses and 3% gtt. We have recently had a new intensivest and I have seen the difference this makes.

[NeuroMedic]

Here is something I came across upon reviewing various resources via the Vanderbilt Eskind Biomedical Library.

Long-term propofol infusion and cardiac failure in adult head-injured patients

http://www.sciencedirect.com/science...66400719af7134

Olaf L Cremer MDa, Karel GM Moons PhDb, Esther AC Bouman MDa, Janneke E Kruijswijk MDa, Anne Marie GA de Smet MDa and Cornelis J Kalkman MDa, ,
aDepartment of Perioperative Care, Anaesthesiology and Pain Treatment University Medical Centre, Utrecht, Netherlands
bJulius Centre for Patient Oriented Research University Medical Centre, Utrecht, Netherlands

The Lancet. Volume 357, Issue 9250, 13 January 2001, Pages 117-118. Accessed from ScienceDirect.com 09/28/2007.

[hepatocyte62]

Originally Posted by gwenith

I have to say that I was not as aware of this but then Propofol is ONLY used for 24 - 48 hours here. It is never used for long term sedation and we tend to use lesser amounts. Cost of the drug is one reason why we have limited use but the other is we have a higher patient nurse ratio in Australia and that leads to lower sedation levels.

How does higher patient/nurse ratio reduce the need for sedation ?
We work one-to-one and use propofol for induction of anaesthesia and to control ICP, if we can reduce it or take it off we do. In critical head injuries (particularly in young people) it is not unusual to use propofol, midazolam, morphine, and a paralysing agent. We try to keep within the recommended 4mgs/kg/hr.

I'd be interested to know what other units use as an alternative outside of the usual opiates and benzodiazepines for unstable ICP.

[Goofball]

Never heard of it; but I have noted that if a pt. is becoming bradycardic, and they are on high-dose propofol, cutting the propofol down will quickly reverse the bradycardia.

[hypocaffeinemia]

Not an RN yet, but just asked several of the nurses I work with in the ICU (and will be interning at upon graduation) and nobody had any idea what I was talking about. All of our vented patients get propofol if sedation is necessary, and we have 4-7 vented per day here, so that's a pretty significant sample size never to see this "syndrome" in.

[2006RNCS]

Originally Posted by methylene

Not an RN yet, but just asked several of the nurses I work with in the ICU (and will be interning at upon graduation) and nobody had any idea what I was talking about. All of our vented patients get propofol if sedation is necessary, and we have 4-7 vented per day here, so that's a pretty significant sample size never to see this "syndrome" in.

I worked in ICU as an RN, and we never experienced this with any of our pts. We used Propofol routinely for our vent. pts. I have found it to be wonderful in keeping agitated, comatose pts. in a more relaxed state.

[nursejill155]

We had a pt who was an MVA with a head bleed who developed this propofol infusion syndrome. It basically caused MODS and the pt ended up coding and dying, he was only 30. It is not common though, I had never heard of it except that one time.