Propofol Infusion syndrome? - page 3

So I obviously know that you use a lot of propofol for sedation in the ICU, and a lot of patient might need deep continuous sedation for extended periods of time depending on what's going on with... Read More

  1. by   Pharmahaulic
    Quote from DaveICURN
    In our unit we have Sedation Vacations ordered every 24 hours of sedation. We titrate down the propofol using the rule of 5 until off. We then wake the Pt and assess mental status and let the pt know about their condition. If the pt tolerates well, we may use other medications to maintain a therapeutic response. if not, then we place Pt back under full sedation and try again tomorrow.
    How long is the vacation sedation? Also, when you put them back under after the sedation vacation like you stated, do you start using the propofol again?
  2. by   Pharmahaulic
    Quote from Julius Seizure
    Actually some DO think high carbs help! There's at least a few journal articles that has been written about it (but it's hard to study something that occurs rarely and that you don't really want to induce on purpose).

    "Adults have larger carbohydrate stores and require lower doses of propofol for sedation than children, which might account for the rarity of this syndrome in adults. The mean total daily calorific intake in our case was only 167·1 kJoules/kg (39·8 kcals/kg), with a carbohydrate intake of 0·9 mg/kg per min on day 1, 2·6 mg/kg per min on day 2, 2·4 mg/kg per min on day 3, and 4·2 mg/kg per min on day 4, which would be insufficient to prevent fat metabolism. A carbohydrate intake of 6–8 mg/kg per min should provide adequate calories to suppress fat metabolism in critically ill children. We suggest that such carbohydrate intake might prevent propofol infusion syndrome."

    Wolf A., Weir P., Segar P., Stone J., and Shield J. (2001). Impaired fatty acid oxidation in propofol infusion syndrome. Lancet, 357, pp. 606-607.

    See also:

    EB Stelow, VP Johari, SA Smith, JT Crosson, FS Apple. (2000). Propofol-associated rhabdomyolysis with cardiac involvement in adults: chemical and anatomic findings. Clin Chem, 46, pp. 577-581.

    (apologies for the poor citation format...I mostly just copy/pasted)
    Thank you very much for the references! Where did you find these?

    Also, why do adults require less propofol for sedation than adults if they are larger. Wouldn't that mean they require more?
  3. by   wtbcrna
    Propofol infusion syndrome isn't as common anymore because we don't use propofol infusions in as high doses or as long as we used to. Propofol like most infusions will slowly enter all tissue compartments and absorb. To start to figure the duration of effect after being on an infusion you have to use context sensitive half life tables. Half-time or Half-life:What Matters for Recovery from Intravenous Anesthesia? | Anesthesiology | ASA Publications
    Propofol infusion syndrome: a structured review of experimental studies and 153 published case reports

    I am not sure why ICU providers don't use remifentanil more instead of fentanyl infusions. Remifentanil has duration of effect of approximately 15minutes after the infusion is turned off. The cost is minimal these days so that should never be an issue. There is also should be a Remimazolam in the future that can be used instead of versed gtts. Remimazolam is supposed to have similar pharmocokinetics as remifentanil.
    Remimazolam - Wikipedia
  4. by   Pharmahaulic
    Quote from wtbcrna
    Propofol infusion syndrome isn't as common anymore because we don't use propofol infusions in as high doses or as long as we used to. Propofol like most infusions will slowly enter all tissue compartments and absorb. To start to figure the duration of effect after being on an infusion you have to use context sensitive half life tables. Half-time or Half-life:What Matters for Recovery from Intravenous Anesthesia? | Anesthesiology | ASA Publications
    Propofol infusion syndrome: a structured review of experimental studies and 153 published case reports

    I am not sure why ICU providers don't use remifentanil more instead of fentanyl infusions. Remifentanil has duration of effect of approximately 15minutes after the infusion is turned off. The cost is minimal these days so that should never be an issue. There is also should be a Remimazolam in the future that can be used instead of versed gtts. Remimazolam is supposed to have similar pharmocokinetics as remifentanil.
    Remimazolam - Wikipedia
    I read that Remifentanil has much less likelyhood of causing nausea and vomiting compared to fentanyl or other opioids because of its rapid metabolism and offset of action. Is thus true?
  5. by   wtbcrna
    Quote from Pharmahaulic
    I read that Remifentanil has much less likelyhood of causing nausea and vomiting compared to fentanyl or other opioids because of its rapid metabolism and offset of action. Is thus true?
    Nothing that I saw would suggest RF is less nausea provoking than Fentanyl.
  6. by   Pharmahaulic
    Quote from wtbcrna
    Nothing that I saw would suggest RF is less nausea provoking than Fentanyl.
    Speaking of, do you use any barbiturates where u are?
  7. by   wtbcrna
    Quote from Pharmahaulic
    Speaking of, do you use any barbiturates where u are?
    No barbiturates usually the icu does propofol or versed/fentanyl. I will occasionally see precedex used.
  8. by   Pharmahaulic
    Quote from wtbcrna
    No barbiturates usually the icu does propofol or versed/fentanyl. I will occasionally see precedex used.
    Does precedex cause a lot of nause or vomiting as a side effect? Compared to other sedatives or anesthetics?
  9. by   wtbcrna
    Quote from Pharmahaulic
    Does precedex cause a lot of nause or vomiting as a side effect? Compared to other sedatives or anesthetics?
    Not usually unless the BP gets low.
  10. by   Pharmahaulic
    Quote from wtbcrna
    Not usually unless the BP gets low.
    Oh yes, I forgot low BP could be a nausea and vomiting trigger.

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