Order of preference for sedation?

[rhkenji]

I'm a fairly new ER RN. I'm on my own for the past 2 months with 1 month preceptorship before going solo.

Our sedative of choice for intubated patient is propofol, they usually go for versed if bp is unstable or we add a pressor with propofol and titrate it with the bp.

On a stable patient, we usually go with propofol and then add versed if they propofol is inadequate to achieve desired sedation.

My question is, if I have both propofol and versed. which should I prefer to max out first before maxing out the other.

1). Max out propofol, then add versed

2). Prefer versed: so lower propofol while increasing versed. Max out versed first before propofol.?

3). Keep everything in the middle - titrate propofol based on its effect on BP, and then backit up with titrated versed as needed

What would you prefer? If BP is not an issue

[offlabel]

There is another thread around that discusses versed and its drawbacks in the elderly, so that's been said. Ultimately, as long as we're not talking about an elderly patient, it doesn't matter, IMO. If the goal is to sedate the patient, use whatever you have to the extent you have to use it. That said, you could use something else instead or in addition to as well. Personally, I'd skip the versed all together and add precedex to the propofol. If that was still insufficient, I'd add a narcotic or just paralyze the patient.

[MedicFireRN]

One of the big things to consider here is your facility's policies on titration. IMO, because of how they want us to titrate versed vs. how we can titrate propofol, I usually get much better sedation out of propofol than from versed. Versed we're only supposed to titrate by 1 mg q 10 min, whereas we can titrate propofol by 5 mg q 10min. Your mileage may vary depending on facility protocol.That being said, I have had patients where their hemodynamics made the choice in favor of versed over propofol, and in those cases I often need to bolus doses of versed while titrating the drip to achieve adequate sedation.

[MunoRN, RN]

Benzo's should be avoided as much as possible, particularly versed, so that' usually last on my list. Generally you should provide analgesia as part of sedation, which means usually starting with fentanyl. We usually use either propofol or conservative amounts of ativan for sedation in addition to analgesia. Although sometimes you're using as much fentanyl/propofol/benzo as you can get in 'em.