Propofol Abuse Growing Problem for Anesthesiologists - page 3

... Read More

  1. Visit  pebbles profile page
    0
    We had an anaesthesiologist who committed suicide a couple years ago, using a propofol infusion. (His addiction was apparently fentanyl).

    It's pretty scary how easily these guys can access drugs. They sometimes walk into the ICU with labelled syringes in their pockets of midaz, roc, etc. so they can get the pt sedated prior to entering the OR.
  2. Visit  hypocaffeinemia profile page
    2
    Quote from pebbles
    We had an anaesthesiologist who committed suicide a couple years ago, using a propofol infusion. (His addiction was apparently fentanyl).

    It's pretty scary how easily these guys can access drugs. They sometimes walk into the ICU with labelled syringes in their pockets of midaz, roc, etc. so they can get the pt sedated prior to entering the OR.
    They need the access, though.

    Just like we have a couple of RSI kits in our pyxis fridge which is easily overrideable that has all that and more.
    Altra and azhiker96 like this.
  3. Visit  nursemarion 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.
    I think like fire we have three elements that lead to this. With fire you need fuel, heat, and a source of O2. With substance abuse we need exposure, risky behavior, access to the drug. Many in the OR are exposed. The anesthesiologist has the greatest exposure by his/location near the patien'ts head. Some in the OR have the tendency to be willing to engage in risky behaviors- trying new drugs, stealing. But, few in the OR have access to the drug. Drugs are controlled by location and access. The anesthesiologist has that access. Therefore, the anesthesiologist who has the sum of all the Xs (or risk factors) equals Y (potential for substance abuse).

    I have to wonder why anyone would abuse a drug that might stop your respiratory drive while you are using it? That to me is a sign of almost suicidal behavior- the equivalent of Russian Roulette.
  4. Visit  CrufflerJJ profile page
    0
    Quote from KimQCRNA
    ......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...
    OUCH! That would not be a good way to go - suffocation. Nasty, nasty, nasty.
  5. Visit  rjflyn profile page
    0
    Access to it in some ER's is not to hard either. It sits in the pyxis on a shelf next to other fluids and could easily be grabbed by someone who chose to abuse it. It would be missed though, as every place I have worked when you actually used it wanted to know how many there were when you actually took one out, at that point it would trigger a discrepancy if the count was off. Yeah I know its not controlled but every place I have ever been able to use it treated as such for inventory purposes. That and our sharps boxes were big enough to handle the bottle if there was excess or left overs. I do know one facility that required all waste to go down the drain as they had busted housekeeping stealing sharps containers and taking drugs from them.

    Rj
  6. Visit  cardiacRN2006 profile page
    0
    Quote from hypocaffeinemia
    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.
    That's right. At 12 hours, whatever is left in the bottle is tossed and replaced. Doesn't happen very often, except for those on low doses. Usually we change the tubing a little early, etc.

    But, I have tossed a partially full bottle of propofol in the garbage before.
  7. Visit  azhiker96 profile page
    3
    Quote from NurseKitten

    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.
    You are correct NurseKitten and I want to apologize for my comparison. You do need a wide variety of meds in hand to be able to treat the patient when their BP spikes up or down, HR races or bottoms, pain, nausea, MI, etc. I really don't begrudge anesthesia having the drugs in their pockets so they can respond quickly. I apologize for my poorly thought out comparison.
    Altra, NurseKitten, and 4hana9 like this.
  8. Visit  azhiker96 profile page
    0
    I think propofol is considered a low risk for abuse because it's so dangerous that it's unlikely to be sought out. A tiny dose to knock you out, a little more stops respiration, more still will drop blood pressure. I've always backed off the drip so I don't know what comes next for a ventilated patient but I bet it wouldn't be good.
  9. Visit  hypnos profile page
    0
    So sad isn't it? In the ICU I've used propofol so much & never once thought about someone becoming chemically dependent on it for recreational purposes. I'm pretty sure I've inhaled a LOT of aerosolized fentanyl and propofol exhaled by patients in the ICU but never developed a craving for it!! Obviously this would be much more intense in the OR setting but still....not sure if I agree with that theory....
  10. Visit  beerose profile page
    1
    I was totally unaware about the abuse of propofol. I am well aquainted with the drive of addicts, but I had also had not heard about doctors and nurses being found with a heplock in the foot. At our hospital the double checks are in place for giving it and now I'm sure proper disposal rules are next. I remember the days when we bent and then broke the needles off of the syringe barrel (using our bare hands) so heroin addicts could not get the needles. No one cared that we got stuck back then. Thanks all for the propofol insight. Sad it had to come on the heels of MJs death.
    RN BSN 2009 likes this.
  11. Visit  lamazeteacher profile page
    0
    Quote from hypnos
    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.
    I'm concerned about aerosolization, too. One would think that an anaesthesiologist repeatedly inhaling the stuff, wouldn't function well, ya think? Especially since their masks hang below their noses......
  12. Visit  KimQCRNA profile page
    2
    Quote from NurseKitten
    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.
    Dear NurseKitten:
    It wouldn't be hard to slip an LMA in and bag him until he comes back breathing...hope they have suction and a pulse ox...NPO status is always a question....and yes it does sound like a pretty good TIVA until the propofol wears off (quickly), I just don't see them doing an infusion.... and then the danger of aspiration if there is an LMA in...as well as laryngospasm...and doubt if the at home doc knows what to do about that...maybe just an oral airway with some supplemental O2......and exactly WHAT training does this so called doc have?? I heard he was a cardiologist......and last time I checked, they don't get a lot of anesthesia training in their fellowship..........
    NC29mom and NurseKitten like this.
  13. Visit  Skeletor profile page
    0
    Quote from cardiacRN2006
    That's right. At 12 hours, whatever is left in the bottle is tossed and replaced. Doesn't happen very often, except for those on low doses. Usually we change the tubing a little early, etc.

    But, I have tossed a partially full bottle of propofol in the garbage before.
    At a facility I worked at before, I would peel away the foil cap surrounding the rubber top of the propofol bottle with my hemostat and pour out the remaining dose into the drain before discarding it.

    It's a suggestion worth spreading around. . .


Nursing Jobs in every specialty and state. Visit today and find your dream job.

Top
close
close