If any of you care, there is a nice little sizzling thread going on in GI under the heading Propofol.

Passin Gas,

According to Barash propofol does have a direct myocardial depressant effect. It also decreases SVR causing it to produce a more profound hypotension than thiopental.

Isn't the direct depression because of the inhibition of sympathetic responses leading to parasympathetic dominance in the CV system (like bradycardia or even asytole). Add this to the vasodilation and you can see how this could cause huge problems anywhere the pt is, but especially if they are not near properly trained personnel. The GI labs and other places that are practicing like this will have problems sooner or later. Hopefully as many people won't die as did when Versed first came out and was used in a similar way.

Passin Gas,

According to Barash propofol does have a direct myocardial depressant effect. It also decreases SVR causing it to produce a more profound hypotension than thiopental.

Yep, you're right. I stand corrected (and I corrected my post). I know the hypotension is more profound with propofol and knew it had arteriolar vasodilation. Somewhere in time I deleted the myocardial depression.

PG

This is a very interesting abstract about propofol. I wouldn't be surprised if the FDA looks closely at it and changes the guidelines for its use. For everyone who thinks this is a safe drug, please read this and then let me know what you think.

Yoga

1: Anaesthesist. 2004 Sep 23 [Epub ahead of print]

Related Articles, Links

*

[Propofol infusion syndrome]

[Article in German]

Motsch J, Roggenbach J.

Klinik fur Anasthesiologie, Universitatsklinikum Heidelberg.

Propofol infusion syndrome has not only been observed in patients undergoing long-term sedation with propofol, but also during propofol anesthesia lasting 5 h. It has been assumed that the pathophysiologic cause is propofol's impairment of oxidation of fatty acid chains and inhibition of oxidative phosphorylation in the mitochondria, leading to lactate acidosis and muscular necrosis. It has been postulated that propofol might act as a trigger substrate in the presence of priming factors. Severe diseases in which the patient has been exposed to high catecholamine and cortisol levels have been identified as trigger substrates. Once the development of propofol infusion syndrome is suspected, propofol infusion has to be stopped immediately and specific therapeutic measures initiated, including cardiocirculatory stabilization and correction of metabolic acidosis. To increase elimination of propofol and its potential toxic metabolites, hemodialysis or hemofiltration are recommended. Due to its possible fatal side effects, the use of propofol for long-term sedation in critically ill patients should be reconsidered. In cases of unexplained lactate acidosis occurring during continuous propofol infusion, propofol infusion syndrome must be taken into consideration.

This is very scary Yoga! We routinely use Diprivan to sedate our vent pts in my MICU sometimes for up to 2 weeks. We recently had a suicidal pt who could not be weaned off the vent, and ended up trached, he was so combative, restless, pulling at all his lines that the Diprivan stayed not just maxed out, but almost twice the recommended dose to keep him in the bed at all! This lasted for three weeks, not to mention he was also getting haldol, morphine, and I forget what else in combination with the Diprivan. We finally got him switched to a precedex gtt. I knew what a serious drug Diprivan was, but the posts here and in the GI discussion have really enlightened me and made me more cautious now. It's pretty much expected for most of our vent patients to be on Diprivan, but I'm definitely reading more about the drug now and opening my eyes to the possible effects of its use. Thanks for the info.

Propofol

Why can I not access that thread? Was it removed?

It was there last night...not this morning!? There is definately no right to free speech in these forums. As soon as something controversial is discussed it magically disappears. If you don't approve, go elsewhere!

Post temporarily removed for Moderator/Admin team discussion due to personal attacks. Thread returned, temporarily closed for 24 hours for cool down.

Any concerns can be addressed to Admin via Site Feedback forum.

Tell me more about this propofol infusion syndrome. What are the symptoms? Has it caused deaths?

We use propofol very sparingly in my unit, and almost never for more than 24-48 hrs. For our long-termers we use Ativan and fentanyl or morphine. These aren't great because the patients take days to weeks to wake up when the drips are dc'd, and also there seem to be a significant number who can't be snowed by any dose of Ativan. I helped turn a gal today who was on 32 mg/hr and she was fighting us, reaching for her tubes and trying to pull her O2 sat probe off. Granted she was at least 350 pounds, but still, that's a lot of Ativan!

I do love using the white stuff, but the more I learn the more I think we are wise to be so careful with it. Can't wait til we find a safer drug that knocks people down quickly and wears off quickly.

There is discussion on this, and links to websites on prop inf synd under med surg ICU section...under critical care forums.

Propofol Infusion Syndrome

Just in case anyone is interested, I was told today by a FNP who attended the TNA (Tenn Nurses's Association) national conference that the anesthetists in the state of TN got a resolution passed giving their position statement that Diprivan should only be administered by anesthesia, period. Very interesting, I'm going to check out the website on TNA and the nurse anesthetists position for myself, as she was also saying they are even against using it in the ICUs for vent pts.

She said this comes from the CRNAs viewpoint that it is not that they don't feel RNs are trained/professional enough to administer the drug, simply that they are not trained to manage the airway if problems occur. I told her I did not think that part was correct (about banning use in ICU settings) becuase pts on the vent w/ ETT in place have an airway maintained. Any CRNAs/SRNAs in Tennesse have any additional comments or views on the subject? I just thought it was pertinent since there was such a debate about it in the GI forum.

Also interesting to me, was that someone quoted the stat that approx 98% of CRNAs are members of their professional organization, the AANA, and that they have more pull if you will to get things passed at such conferences. I think that speaks well for CRNAs and hope that in the future they continue to be so active. It really makes a difference for the profession/specialization of CRNAs.