propofol infusion syndrome

One of the problems associated with propofol use is the result of not providing "drug holidays" as should be done daily. All patients receiving any long-term sedation should receive drug holidays. It's always amazed me how nurses can say they evaluated the neuro status of patients yet never lifted them from the sedation. This just isn't possible. I lift my patients every single hour when I perform my neuro assess, unless there is contra-indication such as status, or extreme increases in ICP, etc.

Had a pt yesterday who was taken off propofol, due to propofol induced pancreatitis, and green urine (a ugly green too). Pt was having issues with DIC also. BUT this was the only thing that worked to decrease her ICP. After d/c the drip her ICP was in the 30-40 range all day with paramaters to keep less than 30. Versed and Fentanyl gtt's didn't work, mannitol didn't work either. I have today off so I have no idea what they did for her. So I can see why the drug is only for short term sedation.

Did they try 3% NaCl? A bolus (typically 2-4 mL/kg) and then start a gtt??

I have to say that I was not as aware of this but then Propofol is ONLY used for 24 - 48 hours here. It is never used for long term sedation and we tend to use lesser amounts. Cost of the drug is one reason why we have limited use but the other is we have a higher patient nurse ratio in Australia and that leads to lower sedation levels.

Not an RN yet, but just asked several of the nurses I work with in the ICU (and will be interning at upon graduation) and nobody had any idea what I was talking about. All of our vented patients get propofol if sedation is necessary, and we have 4-7 vented per day here, so that's a pretty significant sample size never to see this "syndrome" in.