Ativan IVP vs Propofol gtt - page 2
by General E. Speaking, RN 8,647 Views | 23 Comments
Had a patient on Propofol gtt (and Fentanyl gtt @75mcg/hr). S/P laparotomy. Possible aspiration- he was on a vent (PSV). He was lethargic but calm and arousable and would follow commands. Pulmonologist calls and I update on... Read More
- 0Jul 1, '11 by General E. Speaking, RNQuote from LetsChilltrue. We did switch him to A/C.In the CVICU, we would frequently use a Precedex gtt as we weaned off the Propofol, and then continued with the Precedex through the night until extubation in the am. Precedex will keep the patient relaxed and relatively pain free without causing respiratory depression.
Sounds like a lasix gtt is also in order. IV ativan is for agitation. The patient was agitated because he was breathing through a straw while swimming in his own fluid. Lets fix the problem instead of masking it. Lets get rid of the fluid and keep the patient calm and pain free.
Precedex and Lasix.
Hope the patient did well.
- 0Jul 1, '11 by wtbcrna GuideQuote from meandragonbrettPrecedex does have analgesic properties and can/is used as the sole sedating/analgesic quite often.Dex is not an analgesic and the patient would still need some sort of analgesic support.
- 0Jul 1, '11 by meandragonbrettQuote from wtbcrnaExcellent! Thanks for the article. I was unable to find anything while at work regarding it's analgesic properties.Precedex does have analgesic properties and can/is used as the sole sedating/analgesic quite often.
- 0Jul 2, '11 by suannaQuote from detroitdanoReally? We frequenty switch to propofol from the benzos when we want to wean from the vent. I haven't seen resp depression on Propofol except at extreme doses- (50+ mcg/kg/min).Propofol is a severe respiratory depressant, Ativan can do the same but is dose dependent, 1-2 mg Q1H is reasonable. Think of your CIWA patients; you wouldn't be allowed to push 4mg Q1H if it caused severe respiratory depression in every patient.
Someone on PSV should be sedated with another drug. You can argue Morphine is a respiratory depressant too, heck seems like all our drugs are, but Propofol is a heavy hitter. PSV makes the patient work to breathe, you can breathe the rate/TV on A/C and put no effort forth if you want.
Sounds like your pulmonary doc was more concerned about getting the guy extubated since he didn't really have a respiratory issue beforehand (just surgical), but he was being a bit laissez-faire about his BP and agitation. Someone with fluid overload who is too awake is going to be agitated as all get out (granted he needed it and it wasn't just replacements in surgery, but a laparoscopic shouldn't require you to need 6L replaced if I'm not mistaken). If he really wanted the guy extubated he should have come to see the patient and decide whether he could wait a day to be extubated, start a Lasix gtt, something.
Good on you for calling again and again. Hope you documented your butt off though!
- 1Jul 2, '11 by MomRN0913I always hated shutting off the propofol when weaning a patient. Some become extremely agitated and it interferes with their weaning. I have had patients be easily arousable on a certain amount of propofol. I say if they are weaning, their RR is >12 and they are pulling in their volumes, let them have the good stuff until they are closer to extubation, as in almost right before I have had a few pulmonologists give the OK for that on certain patients.
I think the problem in these situations as described above is that the MD is not there to fully assess the situation, the patient. They would have known patient needs to be on A/C because of wet lungs, given lasix, and can be placed back on propofol being the patient is resting on A/C.
- 1Jul 6, '11 by divaRN*i have had too many doc ask me to shut off propofol to assess readiness to extubate... then leave.. and make me chase them to get them back in the room to assess the pt after an hr off gtts, p*ssed off, bucking the vent and making too many attempts to self-extbate. grrr its aggrivating. so easy for the docs to say turn off sedation and walk out while we are the ones trying to keep the patient safe.
- 0Dec 2, '13 by my_purposeThis post is extremely helpful, extremely. I'm a new grad in the ICU and in my second phase of titrating drips with more difficult patients. Had a case where the night prior pt was on propofol and ativan. We were weaning off propofol and titrating ativan to make patient comfortable. Come back and patient is off propofol, ativan 2mg no titration. 30 minutes prior to shift change, pt given 5 of verses for agitation. Pt starts bucking vent, doc comes down orders 5 more versed. No change in patient. Docs go sit st desk to discuss plan for pt ( I'm assuming). My preceptor literally pushes me outing the room to get more drugs for the pt. got order for 10 of versed, pushed, pt was fine. Eventually got order for propofol.
I know that was a lot, but my question was why ativan vs propofol, initially?