Specialties CCU


Does anyone have policy/procedure for titrating Diprivan drips on Vented pts. Do you use Ramsey scale ie. to document? This is not for postop open heart, we already have that one.



In our unit, we titrate Diprivan for effect, the turn the drip off approx every 4 hours or so to neurologiclly assess the patient. Unfortunately, becuse of the high cost of the drug, we don't use it very often. I have been trying for years to be an advocate for Diprivan, especially in Open Hearts because of the ease of weaning patients from the vent. I will try to get hold of our specific policy and send it to you. Good Luck, Carol



What is the Ramsey scale?? and where could i find a copy/example of it?

Besides using Diprivan on vent patients, we also use it to sedate patients going through DT's, and overnight on patient's somewhat psychotic from sleep deprivation, so they won't injure themselves or pull out lines...but then, our ICU director is somewhat unorthodox........we use just enough to enable them to become easily arousable, but then drop right back off to sleep.


Hi, so you have used this on unintubated patients, interesting! I have only seen it used on cardioversions with anesthesia standing by (never used though)

Ramsey Scale-

Light Sedation:

1. Anxious, agitated, or restless

2. Cooperative, oriented, tranquil, and accepting ventilation

3. Brisk response to nail bed pressure or loud auditory stimulus

Deep Sedation:

4. Sluggish response to nail bed pressure or loud auditory stimulus

5. No response to nail bed pressure or loud auditory stimulus, but does respond to painful stimulus

6. No response to painful stimulus





Our unir director is an anesthesiologist, and we have 24 hour on site coverage by an anesthesia resident, but since they rotate q month, the nurses have more experience using an infusion than some of the residents. We are usually given a range of dosages to titrate to effect.


At our unit(C.C.U.)we use Diprivan also for patients on ventilation. We titrate the infusion till the patient is in a sleep, deep enough to to accept the ventilation but in the same time you can wake him up easely. You can control this by knocking softly above the nosebridge. Always be alert for ABP falldown with starting up the drip because of the "first dose effect"!!

We titrate Diprivan to effect using a scale from alert to obtunded. I have also seen Versed gtts used for sedation on vent patients. I worked with a pulmonologist that went to a seminar and when he came back, he ordered only Versed. For those in DT's, Ativan gtts work well and don't seem to have the hypotensive effects.

I have used the Ramsey Scale with intubated patients on morphine/versed drips. We would sedate them on night shift and start weaning down the drip at around 5am. This would allow for a good night's rest so that the patient would be less fatiqued during weaning trials during the day shift.


miss bee

We also use Diprovan onn vented pts. Our policy is that we only use it on pts with an ET tube in place. We have used Versed continuous gtts with morphine prn to good effect also.

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