Propofol Abuse Growing Problem for Anesthesiologists - page 2

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  1. Visit  Anxious Patient profile page
    3
    Quote from cardiacRN2006
    Propofol?
    I dont' get it! I mean, it wears off in like, 36 seconds. How could it be used for insomnia?
    Of course all the doctor blogs are discussing propofol in relation to the MJ incident.. This is what one doctor speculated about Jackson's use of the drug.
    I think the goal here was not to remain sedated for the entire sleep period, but rather to have a brief period to use the drug to feel refreshed afterward. Apparently, there are some studies that suggest that propofol has the ability to erase one's overall feeling of cumalative sleep deprivation. If that is truly what his goal in using it was, in fact, he may not have had more than a couple of hours of sleep daily in many years, due to the artificial feeling of refreshment.
    And it might be why other sleep-depreived people (like docs and residents) use it.

    http://www.kevinmd.com/blog/2009/07/....html#comments
    CityKat, leslie :-D, and cardiacRN2006 like this.
  2. Visit  cardiacRN2006 profile page
    0
    Quote from running_nurse

    It's a bit more controlled now in the Pyxis, but there is still the override function.

    Our's isn't even in its own compartment. Meaning, I can go in and pull out tylenol or heparin flushes, and the propofol is just sitting next to it. So, it's about as controlled as tylenol!

    I wonder if pharmacy will change it's mind with all this MJ media coverage.
  3. Visit  PICNICRN profile page
    0
    I too have always wondered why the heck is this stuff not wasted??? We just pull out a bottle and throw it in the trash when we're done too. Apparently, I could have been making a whole lot of "extra income" over the years by sticking it in my pocket!~kidding!!
  4. Visit  Old Devil profile page
    0
    I was shocked when I heard Propofol could be abused. We had an anesthesiologist who "passed out" during a case, turned out he had a butterfly in his foot and was giving himself Propofol. He ended up losing his license. It was a shame because he was a great guy.
  5. Visit  NurseKitten profile page
    7
    Two points here:

    If MJ wanted a refreshing sleep, he's choosing the WRONG drug. Anesthesia induces NON-Rem sleep, and that's not refreshing in the least!

    Dexmedetomidine is a much better alternative, or even Clonidine, for cryin' out loud...and Clonidine doesn't have to be ICU-monitored! I've seen it used MANY times as an adjuvant for insomnia medications.

    Anesthesia does have access to drugs. We make up a good deal of the substance abuse, but a small percentage of healthcare providers.

    I can't speak to why this is, but for someone to imply we "hit the Pyxis like a Saturday Sale" (I forget the exact words) is downright offensive!

    If IT hits the fan during surgery, we can't just leave our patient to go to the Pyxis. We MUST have everything we even think we could concievably need right at our fingertips.

    We are taught to prepare for every eventuality, because WE ARE RESPONSIBLE FOR THAT PATIENT'S LIFE ON THAT TABLE.

    And until you know what all those eventualities are, do not be talking trash about our efforts to make sure we are prepared to meet every last one of those challenges head on.
    RN BSN 2009, Altra, NC29mom, and 4 others like this.
  6. Visit  carolinapooh profile page
    0
    Quoted from Anxious Patient's post (in regards to MDs discussing the MJ-propofol connection):

    I think the goal here was not to remain sedated for the entire sleep period, but rather to have a brief period to use the drug to feel refreshed afterward. Apparently, there are some studies that suggest that propofol has the ability to erase one’s overall feeling of cumalative sleep deprivation. If that is truly what his goal in using it was, in fact, he may not have had more than a couple of hours of sleep daily in many years, due to the artificial feeling of refreshment.

    Anyone else disturbed by how calm this discussion is? (And as a side note - yikes - a couple of hours' sleep daily in YEARS? Should that be the case, the guy literally wore himself out.)

    I have no idea how large of a container propofol comes in, but I know that personally I don't throw any drug container in the trash - I toss it all in the sharps bin.

    That said, it IS amazing how (almost) blase we find ourselves getting about stuff because we're around it all the time.
  7. Visit  lamazeteacher profile page
    0
    Quote from nolabarkeep
    "Anesthesiologists may be unwittingly driven to substance abuse through chronic exposure to aerosolized fentanyl and propofol exhaled by patients in the OR."
    Why is this exclusive to anesthesiologists? Shouldn't this also affect everyone else in the OR? Also, I would assume that a large percentage of Pt's in the OR are intubated. This would lessen direct contact with exhalation. I would like to see other studies on abused drugs by anesthesiologists. I would bet that propofol is on the lower end of the abuse scale.
    In my (long ago) experience working in an OR, many anaesthesiologists eschued wearing a mask. Others working in the rooms, did wear them appropriately. I also saw that more recently, as a patient.

    I went to the article sited, and made the suggestion that in further planned studies about addiction to propofol, those who wear masks habitually in the OR have the blood and hair tests pre and post surgery, as would the anaesthesiologists. That would rule in or out harmful effects of not wearing a mask. Of course the surgeons and surgical nurses in the room are further away from aerosolized agents. The circulating nurse would be a fairly good "control" subject, as he/she leaves the room during surgery.

    OSHA would need to be made aware of the numerical results of the studies.
  8. Visit  KimQCRNA profile page
    6
    I'm a CRNA and I cannot BELIEVE that anyone with the LEAST bit of medical knowledge would give someone an anesthetic agent at his HOME. Yes, it's true that Propofol is not a scheduled drug...which I was somewhat surprised by when I was in anesthesia school. I haven't actually THOUGHT about that for years as it just lays in the cart and we get used to things being the way they are. However, every hospital I've worked in has some way of locking up all drugs, even the nonscheduled drugs. Either a locking anesthesia cart or a tackle box of some sort that locks. But to think that someone would abuse diprivan is just amazing. You're not even conscious after 20 seconds so how good could it be?? On another note, Michael did have access to all kinds of things......and I once worked at a hospital where a scrub tech decided to commit suicide and got ahold of an amp of sux (succinylcholine), depolarizing muscle relaxant...and injected it and chose to commit suicide...I don't think that was Michael's intent but he must have really wanted the propofol...and where there's a will, there's a way...
    Altra, NC29mom, Andrew, RN, and 3 others like this.
  9. Visit  cardiacRN2006 profile page
    0
    Quote from carolinapooh

    I have no idea how large of a container propofol comes in, but I know that personally I don't throw any drug container in the trash - I toss it all in the sharps bin.

    100ml bottles. They don't fit in most sharps containers, only the ones with large openings.
  10. Visit  NurseKitten profile page
    0
    Quote from KimQCRNA
    I'm a CRNA and I cannot BELIEVE that anyone with the LEAST bit of medical knowledge would give someone an anesthetic agent at his HOME. Yes, it's true that Propofol is not a scheduled drug...which I was somewhat surprised by when I was in anesthesia school. I haven't actually THOUGHT about that for years as it just lays in the cart and we get used to things being the way they are. However, every hospital I've worked in has some way of locking up all drugs, even the nonscheduled drugs. Either a locking anesthesia cart or a tackle box of some sort that locks. But to think that someone would abuse diprivan is just amazing. You're not even conscious after 20 seconds so how good could it be?? On another note, Michael did have access to all kinds of things......and I once worked at a hospital where a scrub tech decided to commit suicide and got ahold of an amp of sux (succinylcholine), depolarizing muscle relaxant...and injected it and chose to commit suicide...I don't think that was Michael's intent but he must have really wanted the propofol...and where there's a will, there's a way...
    Kim - all we can think of is that SOMEONE had to be helping him without the proper monitoring equipment in place. How hard would it be to pop an LMA down, and assist with a BVM, with an infusion running? Add a little Demerol or one of the Fentanyl brothers, and you have a perfect TIVA.

    Interested in your reponse - I'm still in CRNA training, but my classmates and I picked this one apart the other day while waiting for our turn to renew our PALS cards.
  11. Visit  hypocaffeinemia profile page
    1
    Quote from cardiacRN2006
    100ml bottles. They don't fit in most sharps containers, only the ones with large openings.
    Indeed. And we waste quite a few in the trash cans what with changing the bottle and tubing completely after 12 hours due to infection risk.
    cardiacRN2006 likes this.
  12. Visit  P_RN profile page
    1
    We Had a stretch of time when to anes docs would order propofol for hiccups, chills after surgery, etc. the pharmacy apparently had no problem sending a 250 cc glass bottle for iv.



    I refused to give it; with the charge nurse -me- having between 10 and 15 patients it was not an appropriate order. Plus the fact my OR stint was over 30 years ago. It took administration on call to convince them not to make (order) us to do it and they said if the patient needs it, then they have to go to a unit or PACU or OR holding with an anesthest or doc around.


    That stopped them in their tracks.
    lamazeteacher likes this.
  13. Visit  hypnos profile page
    1
    http://www.anesthesiologynews.com/in...rticle_id=7579

    Such a frightening article. Especially after all the media blitz about Michael Jackson possibly abusing propofol. I suppose I was naive but I never considered this was a med anyone would abuse. Does anyone have any stats related to this? I was curious about the item in the article that states that there may be correlation between inhaling exhaled propofol from patients in the OR.
    lamazeteacher likes this.

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