[ERERER]

Need advice from all you experts out there........ I work in a small ER, we only rarely see critically ill children. but, boy when we do, the adrenaline runs high!! Need some advice, yesterday we intubated a 2 year old, the doc ordered diprivan for sedation, which worked well. not much resources available. the induction dose was on the Broswell tape, but not the maintenance dose. Now, as i am comfortably at home and "googling" about, i find that there is alot of controversy about using Diprivan on kids. What do you use to sedate intubated patients??? where can i find a dosing chart?? what other agent should we use??? generally when we have a kid like this it takes several hours to find an accepting facility to transfer him to, so we need some guidelines..... Appreciate any help you can provide!

[suzanne4]

Versed and Fentanyl drips are used more frequently on kids. Also depends on the reason that the kid was intubated. For strictly respiratory issues, then Versed and Fentanyl are great. If a head injury, diprivan can be great, as you can turn it off, and do a neuro check, and then turn it right back on.

My first suggestion to you, would be to find out what the tertiary pediatric facility in your area uses. And ask them to send you the information that they have. Usually best person to speak with is either the educator for the PICU or the ER. Hope that this helps.

[PedsER-RN]

Need advice from all you experts out there........ I work in a small ER, we only rarely see critically ill children. but, boy when we do, the adrenaline runs high!! Need some advice, yesterday we intubated a 2 year old, the doc ordered diprivan for sedation, which worked well. not much resources available. the induction dose was on the Broswell tape, but not the maintenance dose. Now, as i am comfortably at home and "googling" about, i find that there is alot of controversy about using Diprivan on kids. What do you use to sedate intubated patients??? where can i find a dosing chart?? what other agent should we use??? generally when we have a kid like this it takes several hours to find an accepting facility to transfer him to, so we need some guidelines..... Appreciate any help you can provide!


We usually use Vecuronium (along with morphine), although we do use Ativan, Versed, and Fentanyl. The only time I've known Diprivan to be used in our PER is for consious sedations for ortho reductions in the ER (which works pretty well-it's fast acting but doesn't last too long). As far as what dosing you should use and what to use with it, that all depends on your hospital's policies and the child's response to the meds.

[SFCardiacRN]

Dexmedetomidine(Presidex) is a rather new drug we are using on intubated adults. They respond better than with Diprivan.

[karatenurse]

Diprivan is not indicated for children and we never use it in our PICU. We use Versed, Fentanyl, Vec. One attending even likes Etomidate. At another hospital I worked at, Diprivan was used for short procedures, but if you check a drug book, its safety is not indicated for children.

[janfrn]

We use Diprivan (propofol) a lot in our PICU. We have a practice guideline for it, and use it mostly for sedation in patients we plan to extubate in the next four to six hours. Dosing is 1 mg per kg for procedural sedation and up to 4 mg per kg per hour for infusions. We try to limit the child's exposure to it to no more than a few hours, due to the proarrhythmic (torsades) effect it may have. It is one of those drugs I have a love-hate relationship with. I love that it works really quickly, and that it wears off quickly, and I hate it for those same reasons. Give too much to an extubated patient and suddenly the kid's apneic... and doesn't breathe effectively for up to ten minutes or more. Get your tubing caught in the siderail and you may have a very active toddler trying to get out of bed before your pump has caught on. Some little ones have a hypotensive, bradycardic response to propofol that can be quite concerning. But on the other hand, if you're ready to extubate an adolescent and only need that one "good" ABG on PSV, then it's great. You shut it off and in ten minutes or so the tube's out and the kid's asking for a drink.

My son's dentist uses it for all the work he does on Adam's teeth, mixed with a benzo usually. I stay in the room until he's "out" and then afterwards I recover him in the quiet room... an agreement we came to after our first visit to the office. I refuse to put the IV in though! Adam seems to have a much more prolonged sedative response to the benzo and I'm thinking I may ask not to have any, just the propofol. Maybe then I won't need a forklift to get him into the car!

[Floridanurse]

Diprivan is becoming less common in the adult ICU also due to the risk of symptoms like a stroke that are debilitating. It can put someone in a nursing home for life that otherwise would have recovered from their primary illness.

Call your hospital pharmacist for more information. We utilize our hospital pharmacists to the hilt.

[janfrn]

Originally Posted by Floridanurse

Call your hospital pharmacist for more information. We utilize our hospital pharmacists to the hilt.

We would do that too if we actually had in-house pharmacy coverage around the clock, but we don't. The on-call pharmacist on nights would be really ticked if we called in the wee small hours with an urgent question about a med. And during the day they're just "too busy" to field questions; they usually refer us to our on-line references... which take about 15 minutes to actually find and get into, only to find that the info you want isn't there so you've gotta go back through voicemail hell... "To speak to a pharmacist press 4"... But your point is well-taken. They are a great resource. I hadn't heard anything about CVA and propofol, guess I should do a Google search.

[kids]

There was a long discussion on the use of propofol in the Emergancy Nursing forum last fall. http://allnurses.com/forums/f18/propofol-130833.html