propofol infusion syndrome

Mayflye · Aug 13, 2006

What's next; Mom and apple pie are dangerous to your health? As an ICU nurse, I send a silent prayer on every shift to the wonderful people who invented propofol. We use it all the time, sometimes for a month at rates up to 100/mcg/kg/min. We have a 53 bed ICU with lot of neuro. It is quick to take effect, quick to wear off, and I have never seen any adverse events associated with it, except for hypotension which is where the quick to wear off comes in handy. Of course, it is also great if the intubated pt has hypertension. I also have a background in pharmaceutical research, so I am always interested in data. I know every drug can cause problems in SOMEBODY, but the good for millions outweighs the risk for few. If I'm ever intubated....give me propofol and lots of it!!!

gwenith, BSN, RN · Aug 14, 2006

As I said we do not use it as much and there are the occasional patient who is so resistant that you begin to wonder if hitting them on the head with the bottle would be as effective:devil:

HyperTension · Aug 14, 2006

As an RN who works at a pretty decent general ICU, I have yet to see anything similiar to the events as described. By no means is that saying that it won't happen, just not to me / or my coworkers as of yet.

I would have to aggree with Mayflye about the feelings / opinion about Diprivan / Propofol. I have used to for medical / surgical ICU patients, as well as for open heart recovery (50/50 split between that and precedex)

The part that is concerning me is the use of this with our septic patients, with paticular notice to those with adreneal insuffeciency, inotropic agents. The systemic inflammation --> cytokine production that occurs with septic patients really seems to "up the ante" for the risk of this occuring in the adult population.

I will be the first to say that my exposure to the pediatric ICU group, with notice to sepsis is minimal, but if I should ever choose to transition, this would be a topic that would be really neat to research (not a classy thing to say, but stuff like this is really cool to study up on).

Good topic, maybe could have been presented a bit better, but all in all, something that we as ICU nurses need to be aware of.

john 1947 · Aug 15, 2006

Here is a good case study of the PRIS . The doctor was not able to have this posted in our journal.I would like to know how many vistors to this topic were aware of PRIS .

http://www.theannals.com/cgi/content/abstract/36/9/1453

gradcare, LPN · Aug 16, 2006

Gwenith, Just a thanks for your sites on another post but my impression was that the "milk of human kindness" or diprivan / propofol was well known for patients rapidly developing a need for a greater dose to achieve the same effect tachyphalaxis (I think that is the spelling). My biggest beef with the stuff is that many people forget that it is a lipid so they don't reduce the dosage of intralipids when the patient is on TPN which can lead to high blood lipids but also fat overload syndrome, which I am told is rare but nasty.

gwenith, BSN, RN · Aug 16, 2006

Gwenith, Just a thanks for your sites on another post but my impression was that the "milk of human kindness" or diprivan / propofol was well known for patients rapidly developing a need for a greater dose to achieve the same effect tachyphalaxis (I think that is the spelling). My biggest beef with the stuff is that many people forget that it is a lipid so they don't reduce the dosage of intralipids when the patient is on TPN which can lead to high blood lipids but also fat overload syndrome, which I am told is rare but nasty.

I am referring to those who from the get go need HUGE amounts to keep them even on the bed!! You START at 200 mgm/hr and they are writing notes - might as well drown them in the stuff!!

gradcare, LPN · Aug 16, 2006

I am referring to those who from the get go need HUGE amounts to keep them even on the bed!! You START at 200 mgm/hr and they are writing notes - might as well drown them in the stuff!!

Seen a few of those one of the reasons's I keep trying to get my team to review if they keep needing to go up had several on midaz, diprivan fentanyl, haldol regularly. The reintubation is noramally the only time you get to have the patient looking like someone actually has been looking after them (one lad snapped his soft restraints under all this). Now I know what you mean. :lol2:

cardiacRN2006, ADN, RN · Aug 19, 2006

I just read that only 14 cases have been seen since 1998. I can't even begin to ponder how many people have been on diprivan since 1998! So to say that this is pretty rare is an understatement.

Mymimi · Aug 20, 2006

I have not heard of this syndrome! We use propofol routinely. How do you like the intesivist in your hospital? We have discussed using them, but are not using them at this time.

thanks,

Mymimi

Nurseboy1 · Aug 21, 2006

We usually only see hypotension with Propofol use in our unit. However, we usually use it for intubation. Generally if a patient is a short term intubation such as 24-36hrs, we will use a propofol gtt. Any longer and we use Fentanyl/Ativan gtts

john 1947 · Aug 25, 2006

This was just sent to me from the doctor I am working with to get the word out on PRIS. It might save one of your patients It is in the September 2006 critical care medicene.

the_smurfs · Sep 10, 2006

I have not heard of this syndrome as well..

This drug is routinely used in our surgical & neuro icu.

Some patients can knock out quickly with a small dose of infusion some of them are still very restless with a 100mg/hr infusion...

Thanks for the info.. will check out more on this syndrome & share with my

colleagues