Nurses Pushing Propofol for Conscious Sedation -Your Thoughts? - page 7

by *traumaRN* 21,339 Views | 67 Comments

I would be interested in getting feedback from GI nurses that are involved in propofol sedation in settings with and without anesthesia. Your thoughts and experiences please. Thank you, Randy... Read More


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    Quote from swift125
    sorry wannabecrna...you are wrong.I know a lot of GI docs (not as a nurse) and most skip the dubious benefits of sedation for their own endo procedures. Many patients (myself included) specify fentanyl only (yes, we request this and the doc approves or disapproves the request)............I won't argue with any nurse about this............please lay off the cut and paste "references" your "experience" is lacking..maybe this works as a prison nurse, but in the real world patients have the right to request whatever drugs they want (or refuse) for elective procedures. The physician can agree or not...it's not up to a nurse (CRNA included).............to make this decision.
    Apparently, you are not reading my post very well and if you can't quote a study that did a large sample survey of gastroenterologists then you or I neither one can speak to what the majority of GI docs would want. The GI docs I know would want a anesthesia provider doing the sedation with propofol.

    When I do sedation it is up to me, the patient, and the physician (in that order) how the sedation is accomplished. I have never given a medication for a GI doc that didn't have a physiological reason behind ie. glucagon for an ERCP. When I am doing the sedation as a CRNA then the ultimate choice of drugs is up to me not the physician or the patient if we cannot come to an agreement before hand then the patient and the physician can find someone else to do the sedation. I don't work in a supervised environment, and even if I did I would never be medically directed by a gastroenterologist. What you are suggesting only increases the vicarious liability for the gastroenterologist.

    I don't really care if a person only wants fentanyl for their GI procedure, but the research shows that propofol sedation works best for the vast majority of GI procedures/patients.

    I am not a prison nurse anymore and I haven't been a prison nurse since 1999. I am CRNA and I have worked as an anesthesia provider in several states and several different types of practice, if anyone is lacking in experience it is you. Before becoming a CRNA I provided sedation in ICU setting since 2001.

    FYI: I never provided sedation services to any inmates while a prison nurse.
    Last edit by wtbcrna on Sep 4, '11
  2. 0
    Quote from swift125
    .many patients will not pay for propofol which is often unecessary for screening colonoscopy,,,most of the GI docs get theirs unsedated anyway....any more questions?"

    Quote from swift125
    with all due respect wannabecrna-it's a common sense issue...any any of the doocs at your facitlit...really, you ask for ref???

    Why did you open up the floor to "any more questions," then go on to get all ruffled when there was one?!

    I agree that if you are going to make sweeping statements like "most of the GI docs get theirs unsedated anyway," you should be perfectly willing to back up that statement with data of some kind. If what you say is true, I would find that very telling, so I'd love to see that statement verified.
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    Nurses Pushing Propofol for Conscious Sedation -Your Thoughts?

    *** My thoughts = A normal, standard, safe practice. One that has been in use for a number of years (since 2006) in both the hospitals were I work. It's use is limited to ICU and rapid response RNs in a monitored enviroment.
    If I were having a procedure I would ask for propofol.
  4. 0
    I'll be honest that stuff scares the crap out of me. It does work well for pt's who do a lot of drinking or high tolerance for pain pills, *not processed via liver.
    Outpt setting dental office bagged a pt for over an hour till 911 got there. We were last on the list because we were a medical office.
  5. 0
    Quote from nola1202
    I'll be honest that stuff scares the crap out of me. It does work well for pt's who do a lot of drinking or high tolerance for pain pills, *not processed via liver.
    Outpt setting dental office bagged a pt for over an hour till 911 got there. We were last on the list because we were a medical office.
    Propofol is broken down by the liver just like most other drugs used for sedation. Propofol, like all IV meds, does bypass 1st pass elimination. Propofol works by GABA A receptors which is different than Versed or fentanyl giving it a different site for patients that are harder to sedate. Patients that are chronic pain patients and/or are on benzos usually require higher dosing with propofol just like they do with benzos and opioids.

    Propofol wears off in minutes after a single injection, if you were still effectively bagging a patient an hour after a single dose of propofol it wasn't from the propofol. It was from other co-administered drugs, continued hypoxia/hypercapnia, and/or patient comorbidities.
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    it does work well for pt's who do a lot of drinking or high tolerance for pain pills, *not processed via liver.

    *** is cleared by the liver.

    outpt setting dental office bagged a pt for over an hour till 911 got there. we were last on the list because we were a medical office.

    *** uh, why would you bring this into a discussion about the use of propofol for conscious sedation? obviously if you were bagging that patient for over an hour it was related to something other than propofol.
  7. 0
    I underwent a colonoscopy yesterday - wednesday in Aust. - I was administered with propofol and fentanyl by an anaesthetist.

    No problem.
    Last night and today I'm feeling a bit tired, but otherwise ok.

    The fact I knew nothing during the procedure, felt nothing, awoke afterwards in recovery .... suited me just fine!

    Both drugs get my vote.
  8. 0
    I worke Endo 9 years. I have given lots of fentanyl, versed, demerol. I think with extra training we should be able to give proprofol. Constant monitoring is required and the sedation nurse cannot have any other duties: ie: monitoring vitals, etc. much helping with procedure. This is my opinion. Sandra in 'North east Texas. I also would love to find a job in endo in the Texarkana/Paris, Tx area. Or Idabel, OK. Respond if there are any jobs out there.


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