Propofol Abuse Growing Problem for Anesthesiologists - page 4

by Anxious Patient 20,413 Views | 64 Comments

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  1. 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
  2. 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.
  3. 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.
  4. 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.
  5. 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....
  6. 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.
  7. 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......
  8. 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.
  9. 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. . .
  10. 2
    Question for our CRNAs:

    What's this about aerosolized propofol? Just how much is actually excreted via lung, if any? And with the closed circuits of ventilators, how is this even an issue worth mentioning?
    SillyStudent and azhiker96 like this.


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