Using Propofol for sedation on vented pts? - page 4

Is Propofol used on vented patients? Since the half-life of Propofol is so short wouldn't it be more justified using a longer activing sedative? I assume that Propofol isn't used for long-term... Read More

  1. by   dorie43rn
    The short half life of diprivan lets us do neuro checks daily.

    Dorie
  2. by   NurseMeg
    We use propofol "milk of amnesia" frequently as well. I like it because it has a rapid onset, and (usually) wears off quickly. What I don't like about it is the fact that it's lipid based. It's bacteriostatic, which despite changing tubing q12hrs, can be troublesome. It also can cause triglycerides to shoot up. All in all, though, it's a pretty good drug.
  3. by   meandragonbrett
    Diprivan itself is not bacteriostatic. Studies have shown that when mixed with lidocaine, it can have some bateriostatic/cidal properties.
  4. by   NurseMeg
    oops! wrong term. Thanks, meandragonbrett. What I meant to say was that diprivan (with it's lipid base) may support bacterial growth.
  5. by   blueheaven
    Quote from Scrubz
    Is Propofol used on vented patients? Since the half-life of Propofol is so short wouldn't it be more justified using a longer activing sedative? I assume that Propofol isn't used for long-term vented pts right? Maybe just initially?

    I'm still in school so I have no experience with any of this other than what I hear or see, so thanks for any responses. I was just curious.

    I LOVE "Milk of amnesia" for my vented patients. It's great if you need to do a "sedation vacation". I've seen propofol given for a prolonged period, but the docs tracked the labs daily.
  6. by   egroeg_kyut
    we love diprivan!
  7. by   danamobile
    we use the propofol/fentanyl combo as well, especially for those with sensitive BPs. propofol has less effects than versed for sedation, but we primarily like to use versed/fentanly as propofol comes with the risk of increased infection as well! (but isnt it just lovely stuff --favorite drug ever!) learn the song 'if you need a patient, on the sedation, you better call the diprivan man, the diprivan man!'
  8. by   meandragonbrett
    Quote from danamobile
    we use the propofol/fentanyl combo as well, especially for those with sensitive BPs. propofol has less effects than versed for sedation, but we primarily like to use versed/fentanly as propofol comes with the risk of increased infection as well!

    What do you mean by diprivan having "less effects than versed for sedation?" Are you talking about the half life? Propofol is a general anesthetic and versed is a benzodiazepine. Propofol is going to cause MUCH more sedation than versed does.
  9. by   SLEEPERJC
    Hi Everyone,
    I realy enjoyed this thread. We use "Mothers Milk" by the case. We are always stashing it away for future use.
    Yesterday infact, my patient was very restless indeed. With both fentanyl (250mcg/hr) and ativan infusing (2mg/hr) diprivan was at (30mcg/kg/min) (12.5 ml/hr) patient was tolerating vent. Turn off diprivan and the patient starts to climb out of bed so increased the ativan to 4mg/hr and gave two bolus does Ativan 2mg to no avail
    The patient was going to get a vena cava filter so I drew up 100mcg of diprivan, pushed 50mcg (5ml) and off he went to the OR. Upon his return I was faced with the same dilema. How do I keep this guy from desaturating to 88% because of his restlessness.
    He is 10 days post admission for stabbing/explap with non closure who Has now developed Multiple Resistant Pathogen (MRP). The point that the Attending was trying to make is that eventually the patient needs to come off sedation. I agree.
    I see that all but 1 post chose Versed as benzo over Ativan do you find that it works better and why. We use alot of versed as well. Some times I follow whats being done when I come in. Perhaps had I switched over to versed I would have not needed to place on diprivan. Pt. has hx. chronic alcohol use thanks for reminder to monitor triglycerides/amalase/lipase .
    Feedback
  10. by   meandragonbrett
    Quote from SLEEPERJC

    The patient was going to get a vena cava filter so I drew up 100mcg of diprivan, pushed 50mcg (5ml) and off he went to the OR.
    Why are you giving propofol IV push?

    Quote from SLEEPERJC
    Upon his return I was faced with the same dilema. How do I keep this guy from desaturating to 88% because of his restlessness.
    provided sedation and pain control, 10mg of vec will end the restlessness.



    Quote from SLEEPERJC
    I see that all but 1 post chose Versed as benzo over Ativan do you find that it works better and why. We use alot of versed as well. Some times I follow whats being done when I come in. Perhaps had I switched over to versed I would have not needed to place on diprivan. Pt. has hx. chronic alcohol use thanks for reminder to monitor triglycerides/amalase/lipase .
    Ativan can make folks go super nuts sometimes. Versed has amnesia properties.

    You mention the pt has hx of etoh abuse.....that's why he was restless and was not sedated with 2 of ativan and 250 of fentanyl. The substance abusers burn through sedation like there is no tomorrow.

    Also don't forget to monitor lactate levels for lactic acidosis.
  11. by   SLEEPERJC
    Meandragonbrett,
    The iv (bolus) was the only way I could figure to calm him down. It's rarely given this way except for road trips to CT.
    Did you mean Vecuronium? Paralysis would have worked too. I hadn't thought of that. He had been kept paralized for days. At one point it occured to me that the Ativan was making him worse.
    Our docters are notorius for rounding in the morning and saying turn all the sedation off. What guidelines do you follow, if any regarding "weaning to off"?
    I read somewhere that narcotics be halfed each day untill 0. Sometimes we will start on methadone.
    Sorry for straying from the wonderous diprivan...
  12. by   VegasNurse05
    Do you ever bolus Propofol from your IV pump? If so, how much? Do you have a standing order for it or is it just something you do based on nursing judgement?
  13. by   cardiacRN2006
    Quote from VegasNurse05
    Do you ever bolus Propofol from your IV pump? If so, how much? Do you have a standing order for it or is it just something you do based on nursing judgement?

    Umm, if I want to risk losing my license. RNs (at least in my state) cannot bolus propofol-ever.

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