Using Propofol for conscious sedation

trrinatl · Jul 23, 2008, 11:08 PM

Re: Using Propofol for conscious sedation

I have used propofol a couple of times for CS but generally for vented patients. The information about half life is confusing, the same source says that it's 30 to 60 minutes, then another place in the same source says it's 6 hours. So even if the patient is sensative too it, I"m much more worried about hypotension than long term airway management. Usually bagging them for a couple of minutes is all you have to do. I know we have had some patients in our ICU that went "nuts" usually either DT's or a mix of some bad street drugs; propofol works great as a short acting agent to get them under control until you can get pharmacy to put your ordered drugs in the Pyxis.
The best use I've ever see was a 19 year old male prostitute that was standing, naked, in the middle of his ICU bed. He was swinging his IV bag by the tubing and had already DC'd his Foley (bet THAT hurt the next time he had a trick!). He had his pulse ox cable and was threatening to hang himself from the ceiling, all because his hospitalization for a CHI from a assault made him miss is regular weekly well paying "john". He forgot he had a second IV and the charge nurse managed to get behind him and slide about 4 cc of propofol in his line. In about 30 seconds he just kinda wilted into a naked pile on the bed at which point in time he aquired a new hospital gown, 4 point restraints and a dose of geodon.

alkaleidi · Jul 25, 2008, 12:12 AM

Re: Using Propofol for conscious sedation

In the EDs I have worked at, all of our conscious/moderate sedations (for intubation, closed reductions, etc) require an MD, RN, and RRT present during the entire procedure, and until the patient comes around and is responsive, require the RRT and RN present the entire time... and until the patient is actually sitting up talking, I am in and out of the room almost constantly (never leaving the patient for more than 5 minutes). I have administered Propofol under those conditions several times, and have never had to bag a patient.

Can you please paste links to literature re: RNs administering Propofol for sedation? Thanks!

Booty Nurse · Jul 27, 2008, 06:57 PM

Re: Using Propofol for conscious sedation

I work in Vermont doing GI endoscopy. RNs do not administer propofol; if there is a patient who needs more than Versed and a narcotic, an anesthesia provider will come in and give the "milk of amnesia".

The only time I was responsible for giving propfol was on the med-surg floor, where we were giving it to a young woman dying of cancer. Her pain was just terrible and her morphine tolerance was through the roof. It was the first time anyone had given propofol on the floor and everyone was very nervous about it. It allowed her to die a peaceful death.

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Check out my blog: http://bootynurse.blogspot.com/

swolfe_2 · Sep 08, 2009, 02:08 PM

Re: Using Propofol for conscious sedation

"The best use I've ever see was a 19 year old male prostitute that was standing, naked, in the middle of his ICU bed. He was swinging his IV bag by the tubing and had already DC'd his Foley (bet THAT hurt the next time he had a trick!). He had his pulse ox cable and was threatening to hang himself from the ceiling, all because his hospitalization for a CHI from a assault made him miss is regular weekly well paying "john". He forgot he had a second IV and the charge nurse managed to get behind him and slide about 4 cc of propofol in his line. In about 30 seconds he just kinda wilted into a naked pile on the bed at which point in time he aquired a new hospital gown, 4 point restraints and a dose of geodon."

1. I hope that no one that reads this and thinks this is standard practice because it is not. You would not run up to a psych patient in crisis and push verced......

....(bet THAT hurt the next time he had a trick!).

2. Way to make fun of and exploit your patient, that's super professional.

swolfe_2 · Sep 08, 2009, 02:33 PM

Re: Using Propofol for conscious sedation

"The only time I was responsible for giving propfol was on the med-surg floor, where we were giving it to a young woman dying of cancer. Her pain was just terrible and her morphine tolerance was through the roof. It was the first time anyone had given propofol on the floor and everyone was very nervous about it. It allowed her to die a peaceful death."

I am all about no pain and peaceful death, and also take patient advocacy to the extreme. But, did you know you publicly posted that you took part in what some may consider "Euthanasia"? We all have our "nursing secrets" but we prolly should be cognisant of the things that we share with others........because .......you never know!!

HillaryC · Sep 09, 2009, 01:27 PM

Re: Using Propofol for conscious sedation

Originally Posted by swolfe_2

"The only time I was responsible for giving propfol was on the med-surg floor, where we were giving it to a young woman dying of cancer. Her pain was just terrible and her morphine tolerance was through the roof. It was the first time anyone had given propofol on the floor and everyone was very nervous about it. It allowed her to die a peaceful death."

I am all about no pain and peaceful death, and also take patient advocacy to the extreme. But, did you know you publicly posted that you took part in what some may consider "Euthanasia"? We all have our "nursing secrets" but we prolly should be cognisant of the things that we share with others........because .......you never know!!

Legally it's not considered euthanasia as long as it is being given with the intention of making the patient more comfortable, even if it is recognized that giving propofol may hasten the patient's death. It's a fine line. I had this clarified for me when we had an ICU patient who was completely with it and was being taken off the vent (by his choice) because he was never going to wean. He was given a propofol infusion to make him more comfortable. Perfectly legal. I suppose there are some who would be against this (likely because of their own religious views) and would try to call it euthanasia, but legally it's not.

swolfe_2 · Sep 12, 2009, 03:14 PM

Re: Using Propofol for conscious sedation

The choice of the physician to use propofol for consious sedation turns it into a MAC case. There is no way to tell at what dose the patient transitions from moderate to deep (until after the fact). All you OR/PACU nurses know that during a case the MD cannot perform Anesthesia duties and vice versa. (thus there needs to be 2) The nurses who use it in the ED need to be aware of the effect that it has on cardiac output. Even though the clinical effect is minutes, the half life of the drug is still hours.

You may have never had an emergency yet but...... it happens!

geekgolightly · Sep 13, 2009, 01:03 PM

Re: Using Propofol for conscious sedation

For anyone interested in propofol infusion syndrome, this is an interesting article.

http://ccn.aacnjournals.org/cgi/content/full/28/3/18

wtbcrna · Sep 13, 2009, 02:49 PM

Re: Using Propofol for conscious sedation

Originally Posted by swolfe_2

The choice of the physician to use propofol for consious sedation turns it into a MAC case. There is no way to tell at what dose the patient transitions from moderate to deep (until after the fact). All you OR/PACU nurses know that during a case the MD cannot perform Anesthesia duties and vice versa. (thus there needs to be 2) The nurses who use it in the ED need to be aware of the effect that it has on cardiac output. Even though the clinical effect is minutes, the half life of the drug is still hours. You may have never had an emergency yet but...... it happens!

Actually using propofol does not constitute monitored anesthesia care/MAC. MAC a is term used for billing anesthesia services when an anesthesia provider provides moderate/conscious sedation. For a more detailed explanation see: http://www.asahq.org/Newsletters/199...ates_1298.html (although it can be a CRNA that provides and bills for MAC without the need for an anesthesiologist).

All sedating medications can drop cardiac output. Propofol is quite safe when compared to other sedating medications, but it can be quite detrimental just like any other medication when not used properly. I have coded a patient in the OR after giving 6mg of Etomidate (normal induction dose is usually somewhere around 20+mg), and etomidate is supposed to be one of the safest drugs for cardiac instable patients there is.

The half-life of propofol is hours, but like all drugs its duration of effect is directly related to redistribution (which is minutes in the case of propofol when given as a single injection and not as a infusion).

The reason for this thread was to see if nurses had detrimental outcomes using propofol for conscious sedation that would show possibly an ancedotal difference versus the published research studies for nurse administered propofol sedation.

I am neither for or against RNs using propofol for conscious sedation, but I think if RNs are going to use it they need to have extra training in its use and there should be strict limits on the amount of propofol and other sedating medications used on individual per procedure.

swolfe_2 · Sep 14, 2009, 01:01 PM

Re: Using Propofol for conscious sedation

I am not disputing what MAC means.... As the link states, its not just for billing. In AZ both our hospital and outpatient surgery center policies clearly define that the use of propofol in a procedural setting requires "Monitored Anesthesia", because the training is not universal. We had an incident just last week when our anesthesiologist instructed our circulator to push 40 of diprivan during a lumbar pain block and VS were only taken twice during the 40 min procedure, pt was prone, no anesthesia cart, no airway available. She was unfamiliar with the drugs and gave it anyway, and anesthesia had it "under control". The patient was fine (it's not a question of skills) but her medical record is not. There is a plethera of evidence based practice utilizing these meds however the education is drastically different throughout the specialties of our profession. Mistakes will be minimized if the issue is more black and white instead of gray. Of course, CRNA experiences are on a more advanced level.

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Using Propofol for conscious sedation

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