Sedation..Your thoughts? - page 5

by Da_Milk_of_Amnesia | 8,563 Views | 49 Comments

So I just have a question for my fellow icu RNs. I had a patient last night who while even sedated on 50mcgs/kg/min of propofol and 6 of versed was able to open eyes and follows commands and respond appropriately. I asked her... Read More


  1. 0
    I had a guy the other night I could'nt keep down, post op GSW to the chest had thoracotomy the works you name it, first started out on 75mcg/kg/min propofol, 4 mg versed, 4 mg dilaudid, and he was wild eyed and awake on that much, we finally ended up giving him 125 mcg/kg/min propofol, another 4 versed, 2 mg ativan, and 3 mg more of dilaudid and got him down for about 5 hours on that and then had to snow him again.
  2. 0
    yep... versed or propofol for sedation and amnesia and fentanyl for pain. Propofol in OR is a different ballgame and in the hand of CRNA or Anesthesiologist a totally different scope of practice.
  3. 0
    We're taking a closer look at delirium and the gtts that make it worse; including Versed , Ativan and Propofol. Moving tpowards Precedex. Check out the icudelirium.org site from Vanderbilt.
  4. 1
    We use up to 75mcg/kg/min on the propofol... and sometimes that doesn't even keep the pt comfortable.

    It really depends on the pt and the problem... if you have a pt is full blown ARDS, the idea is to knock out their drive to breath and let the vent do the work... so if that were the case, I would have asked for something more, or even a paralytic. HOWEVER, in any another case where they are less critical, the goal is just to keep the comfortable with the least amt possible. I have pt's that are perfectly ok with no medication at all, and others that need to be completely knocked out cold to not fight the vent. And everything inbetween. I like to be able to assess my neuro status and we always do sedation vacations on all our sedated pts, unless like I said before, the extra critical pts where waking them up would be too risky.

    I think in your case, you did the same thing I would have done.
    Wave Creation likes this.
  5. 0
    Quote from TexICUNurse
    We're taking a closer look at delirium and the gtts that make it worse; including Versed , Ativan and Propofol. Moving tpowards Precedex. Check out the icudelirium.org site from Vanderbilt.
    We used Precedex with post-open hearts consistently. O-m-g it's pretty amazing stuff, but the price of it is just as o-m-g.
  6. 0
    I work in a SICU in Denmark. We do not sedate our patients while intubated, unless there is something that indicates a need for it. F.ex. not being able to accept being intubated, pulling at the tube and so on. Otherwise, it is rare that we sedate. When we do, we use Propofol for short term sedation, and if it is for more than a few days we use Midazolam. (I belive you know it as Versed?) We use Morphin as well for pain and discomfort, given as bolus. Our delirious patients are treated with Haloperidol, if they are very delirious and require constant observation, we will often get extra staff to come and sit with the patient constantly. Research has proven that keeping the patients reduces the length of their stay in SICU and improves their prognosis. Additionally, problems with PTS are reduced.
    I've linked the research article that supports this, currently there is ongoing nursing research into how the patients experience this as well as how we nurses experience caring for non-sedated intubated patients.

    http://crashingpatient.com/pdf/no%20sedation.pdf
  7. 0
    Quote from ICUenthusiast
    We used Precedex with post-open hearts consistently. O-m-g it's pretty amazing stuff, but the price of it is just as o-m-g.
    we used it the first time the other day but it didn't help. the patient still needed 100mcg fentanyl and 70/mcg/kg/min of propofol and still breathing on cpap on vent.
  8. 0
    Has any of you been on a ventilator? Why in heavens name would you not want to "snow" your patient until they are ready to come off the vent? Do they need to be awake for some reason? Why put them through that? Propofol wears off in 5 minutes for weaning! There is increased chance they will self extubate when not sedated, so you have to add restraints. Doesn't make sense to me. We do wake up calls to check neuro status, and if not weaning, its back to sleep for them! If their pressure is affected, the levo would be increased. If a patient has severe PNA, they need that "rest." I've had no luck with Ativan gtts or Fentanyl gtts at keeping the patient comfortable. If your patient keeps bucking the vent, thats horrible for them.
  9. 0
    Quote from dorie43rn
    Has any of you been on a ventilator? Why in heavens name would you not want to "snow" your patient until they are ready to come off the vent?

    Increased risk of VAP secondary to increased ventilator days? There is plenty of research that has related depth/length of sedation to increased ventilator days.

    There is no reason to keep somebody totally snowed. The goal of sedation is to keep the patient comfortable but easily aroused to tactile stimulus.

    I've had patients that are on the vent and be 100% awake, intubated, and watching TV with just some occasional ativan for anxiety.
  10. 1
    Quote from meandragonbrett
    Increased risk of VAP secondary to increased ventilator days? There is plenty of research that has related depth/length of sedation to increased ventilator days.

    There is no reason to keep somebody totally snowed. The goal of sedation is to keep the patient comfortable but easily aroused to tactile stimulus.

    I've had patients that are on the vent and be 100% awake, intubated, and watching TV with just some occasional ativan for anxiety.
    I've worked the ICU for five years and have never seen diprivan increase the length of ventilation. Ativan does, it takes so much longer for it to leave the body.
    If they are awake and accepting the vent, good for them, but if they are bucking the vent, totally uncomfortable, then they need sedated until they are no longer uncomfortable.
    CCL RN likes this.


Nursing Jobs in every specialty and state. Visit today and Create Job Alerts, Manage Your Resume, and Apply for Jobs.

A Big Thank You To Our Sponsors
Top