Dialysis question?

Nurses General Nursing

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Would hemoperfusion (or even hemodialysis or hemofiltration) work for an accidental Propofol overdose (hypothetical) or Benzo overdose?

I ask because I know certain drugs arent able be removed through dialysis or whatever and I couldn't find any information about Propofol or Benzos.

I know Propofol is given by an anesthesiologist so an acvident would be rare and a Benzo has an antagonist but just in a hypothetical situation?

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Specializes in Nephrology, Cardiology, ER, ICU.

You can "technically" dialyze off a lot of meds. However, it is only done in emergent settings as placing a hemodialysis catheter and getting the hemodialysis nurses in to set up machine, run the patient, etc., can take a few hours.

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Specializes in ICU, LTACH, Internal Medicine.

Propofol metabolism is too quick to make dialysis useful.

Benzos are weakly dialisable. They all cross brain-blood barrier pretty quickly, so HD would only wash out molecules still not bound by receptors, fat or albumine, which would be only a small fraction, slightly larger for quick-acting hydrophilic preparations. But in cases of overdose we have flumazenil (Romazicon) to antagonize their action on GABA receptors, so here dialysis would be pretty useless as well.

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Propofol metabolism is too quick to make dialysis useful.

Benzos are weakly dialisable. They all cross brain-blood barrier pretty quickly, so HD would only wash out molecules still not bound by receptors, fat or albumine, which would be only a small fraction, slightly larger for quick-acting hydrophilic preparations. But in cases of overdose we have flumazenil (Romazicon) to antagonize their action on GABA receptors, so here dialysis would be pretty useless as well.

Oh I see so propofol would already be totally metabolized and out of the system by the time they set the machine up?

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You can "technically" dialyze off a lot of meds. However, it is only done in emergent settings as placing a hemodialysis catheter and getting the hemodialysis nurses in to set up machine, run the patient, etc., can take a few hours.

Well I ask because I know some meds or drugs because of their molecular propertis or not "dialyzable" and cannot be removed with dialysis.

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Specializes in Neuro, Telemetry.

Also, propofol is routinely run by nurses in the ICU without an aneasthesiologist. Just something to keep in mind.

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Specializes in Critical Care and ED.

Propofol has an incredibly short half-life. If I gave a 10cc bolus of Propofol the patient would be awake by the time I had primed the dialysis machine. Of course, as we all know from Michael Jackson it's never a good idea to do that on a non-intubated patient because everybody's metabolism is different.

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Specializes in ICU, LTACH, Internal Medicine.
Propofol has an incredibly short half-life. If I gave a 10cc bolus of Propofol the patient would be awake by the time I had primed the dialysis machine. Of course, as we all know from Michael Jackson it's never a good idea to do that on a non-intubated patient because everybody's metabolism is different.

Propofol has very quick and predictable metabolism. Although its t 1/2 can be anywhere between 1.5 and 30 hours, it is metabolized mostly by liver glucoronization, which is quick process which literally go as blood flows unless patient is in obvious hepatic failure or severe shock. So, yeah, the guy will be up and kickin' after a single shot before you even unpack your stuff, probably :) unless there is something else on board.

The problem with Propofol is not the time, but intensity. It's full action can take less than 5 min but it is enough to die if airway is not supported by some mean.

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Propofol metabolism is too quick to make dialysis useful.

Benzos are weakly dialisable. They all cross brain-blood barrier pretty quickly, so HD would only wash out molecules still not bound by receptors, fat or albumine, which would be only a small fraction, slightly larger for quick-acting hydrophilic preparations. But in cases of overdose we have flumazenil (Romazicon) to antagonize their action on GABA receptors, so here dialysis would be pretty useless as well.

How are protein bound toxins removed?

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