diprivan for c sections

jwk · Mar 15, 2006

Just a question out there to see who is using diprivan for stat c sections and who all still use Pentothal and what experiences these have had for you---

Still pentothal where I am, but we probably only do 1% of our C/S with a general. One of the hospitals where I do locums uses propofol. No problems that I've seen.

Nitecap · Mar 16, 2006

STP here too. Usually for stat C-sections where neuraxial not an option. Really as soon as the tube is in they are tearing the baby out. Asked a few attendings and they claimed that propofol may be just as safe as STP however STP has been more extensively studied and has more evidence to support it as being safe with minimal traces found in cord of neonate blood.

Since there is more data to support it we use this for nearly all GA C-sections.

catcolalex · Mar 16, 2006

does the fact that STP can be mixed and set out ready on the cart have anything to do with its prevelence in OB as opposed to propofol that would have to be drawn up at the time?

jwk · Mar 16, 2006

does the fact that STP can be mixed and set out ready on the cart have anything to do with its prevelence in OB as opposed to propofol that would have to be drawn up at the time?

Not really - you can buy pre-filled syringes of propofol that can sit out as long as you want.

Geeg · Mar 16, 2006

Hey, I'm not a CRNA, but isn't dip more expensive??

Nitecap · Mar 16, 2006

Hey, I'm not a CRNA, but isn't dip more expensive??

Yes but not as expensive as it used to be since its been around alot longer and is made by 2 companies now.

sonessrna · Mar 23, 2006

I have heard (and not recently )that propofol has been shown to cause significant fetal sedation. I have never used propofol, don't know. Just what I heard.

sonessrna · Mar 23, 2006

Yes but not as expensive as it used to be since its been around alot longer and is made by 2 companies now.

If propofol is a better drug, cost should not be an issue. Cost should not be the main issue, patient care should. Just my speech. :idea:

jwk · Mar 24, 2006

I have heard (and not recently )that propofol has been shown to cause significant fetal sedation. I have never used propofol, don't know. Just what I heard.

I've never found that to be the case, nor have I ever heard it.

Interesting that propofol is Pregnancy Category B, and pentothal is Pregnancy Category C, theoretically LESS safe, but since pentothal is the old tried-and-true drug, there doesn't seem to be any push to change.

Just a CRNA · Mar 30, 2006

The amount of research that has been done with STP in incredible. We know, almost to the split second, how many micrograms of the drug is showing up in cord blood and how quickly the cord needs to be clamped after injection in order have have safe APGARs. I can't imagine that propofol will ever be studied to that extent. The medical-legal ramification of doing research on gravid females is overwhelming. Would you let your wife be part of a research study as part of her emergency c-section? A purely rhetorical question, of course. Bottom line is that STP is well tested, safe, dependable, inexpensive, and has a duration of action that allows for even a slow OB-Gyn to claw his way into the uterus within given time constraints. I would not want to be defending my decision to use propofol in a c-section if there were a problem of any sort. Can you imagine the string of expert witnesses the plaintiff's lawyers could put together to testify against you? If I can't do neuraxial, it's pentothal for me.

Just a CRNA · Mar 30, 2006

does the fact that STP can be mixed and set out ready on the cart have anything to do with its prevelence in OB as opposed to propofol that would have to be drawn up at the time?

STP is a Class IV controlled substance. JCAHO takes a dim view of leaving controlled meds "out" on a cart if they are unattended.