Using Propofol for sedation on vented pts?

Specialties MICU

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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.

Specializes in Trauma,ER,CCU/OHU/Nsg Ed/Nsg Research.

Our max is 60mcg/kg/min. I had a patient with a hx of narcotic abuse recently, and this didn't even touch her. I was able to add a versed drip to the propofol drip. Of course, after I finally got her sedated, the pulmonologist wanted her extubated. My day went very downhill from there!

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Specializes in Cardiac.
Blue-green urine. Saw it in person once. More common than you think. Also tubing changes very important.

You saw this once? I see it all the time.

And yes, tubing changes are important. We do it q12.

Thanks God we dont' have a max limit. I guess my max limit would be whatever the pt's BP could tolerate while maintaining sedation.

50mcgs is not anywhere enough in 90% of our population!

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Specializes in critical care.

Yeah I have only seen it once, but I am a new grad who has only been around since December. In response to the article search, I tried to look for you, but because I graduated I lost my access to my normal library. I have one article but, only the printed version and the ref isn't there. I will try to talk to the nursing educator. We also do not have a max dose.

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Specializes in Critical Care.

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

Dorie

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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.

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Diprivan itself is not bacteriostatic. Studies have shown that when mixed with lidocaine, it can have some bateriostatic/cidal properties.

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oops! wrong term. Thanks, meandragonbrett. What I meant to say was that diprivan (with it's lipid base) may support bacterial growth.

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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.

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Specializes in ICU/SCU/CCU, TELE, STEP DOWN.

we love diprivan!

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Specializes in GSICU, med/surg.

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 :D--favorite drug ever!) learn the song 'if you need a patient, on the sedation, you better call the diprivan man, the diprivan man!'

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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.

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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 :welcome:

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