Propofol question

Hi,

I'm not a CRNA, but I couldn't think of a better forum to ask this question. I work in a Neuro ICU and of course, we use lots of propofol on INTUBATED patients. We got into a discussion last night about propofol and whether it could be used on non-intubated patients as well. Some people seemed to think that in small doses it would work because of how quickly it works and how quickly it wears off. But I say no. I've seen how fast people can go out w/ propofol and would not feel comfortable giving it to a non-intubated patient (actually I would be terrified!). And no, no one has done it, nor are there plans to do so, we were just having a lively conversation.

That being said, IS propofol ever used on non-intubated patients? If so, is it only anesthetists and nurse anesthetists that would administer it? Am I asking a really dumb question? I've looked online and can't find anything that answers my question either way.

Thanks!

we use it a lot in the ed for reducing serious fractures and/or dislocations. pt's put on O2 and monitored during the procedure as well.

love the stuff.

of course intubation equipment is always around as well as many acls cens, residents, and board certified er physicians, so we're ready for any crash.... but no one's crashed yet.

Hi,

I'm not a CRNA, but I couldn't think of a better forum to ask this question. I work in a Neuro ICU and of course, we use lots of propofol on INTUBATED patients. We got into a discussion last night about propofol and whether it could be used on non-intubated patients as well. Some people seemed to think that in small doses it would work because of how quickly it works and how quickly it wears off. But I say no. I've seen how fast people can go out w/ propofol and would not feel comfortable giving it to a non-intubated patient (actually I would be terrified!). And no, no one has done it, nor are there plans to do so, we were just having a lively conversation.

That being said, IS propofol ever used on non-intubated patients? If so, is it only anesthetists and nurse anesthetists that would administer it? Am I asking a really dumb question? I've looked online and can't find anything that answers my question either way.

Thanks!

Yes, propofol is used all the time in non-intubated patients by anesthesia providers. I use it frequently for light, moderate, and deep sedation. Should only be used by healthcare providers who are trained to take it to the next level...for example, sedation to general anesthesia. We don't get paid to put them to sleep...we get paid to wake them up!

good question- and from your post i am confident it comes from a sincere desire to learn

..there are multiple posts debating this same subject - many RN's feel it is fine for them to use propofol in non-intubated patients as long as an MD is there or there is an airway cart bedside.

those TRAINED in anesthesia don't agree - the manufacturers of propofol don't agree - so there is your answer... it is funny how those of us who know the drug intimately continue to argue this with some who feel they are more than qualified ... good luck.

Would etomidate be a better choice?

One ICU I worked in did use propofol on non-intubated patients for just the reason you are asking about. We called it "milk of amnesia", the patients were watched closely in an 'older era' open ward type ICU. When we upgraded to closed private rooms this became a bit trickier and many patients were intubated whom needed this type of sedation.

We titrated the propofol by monitoring respirations per minute and arousal.

Professional drinkers were the majority of the crowd who tolerated that type of sedation without respiratory depression.

We were infromed at work that part of the MN nurse practice act states a RN can only use propofol on intubated pts. (same goes for Ketamine).

I hate to get into this discussion again, but... If you are not a professional anesthetist (CRNA, MD, AA), you should NOT give propofol on an unintubated patient, particulary in the ER, if they have a full stomach (most ER patients), if there is a chance of cardiovascular collapse or a danger of respiratory depression. Period, Amen

I understand from my legal research that there are a couple lawsuits regarding this in the pipeline. One is an RN who didn't read the package insert on propofol. See you in court. The problem is a few patients may have to aspirate or die before the point is made that propofol is an anesthetic and should be used ONLY by those educated in anesthesia. I don't care if you are ACLS certified or a non-anesthesia physician, only the very best anesthetist can intubate a trachea in a patient who is vomiting solid food.

My last point, so many RNs who are now in anesthesia school or are new graduates, state that they didn't know what they didn't know when they were giving propofol as a non-anesthetist. These people feel very stongly about it.

If you are going to argue with me on this, please state scientific facts and not give a history of how many times you have given it without any problem. I don't want my grandchild to be the next one!! It only takes one to aspirate or die for your record to be broken.

yoga

amen, amen and amen.

We use it all the time in CCU- IV push for cardioversions at the bedside of our beloved symptomatic Afib with RVR patients (who are not intubated), and continuous IV for sedation of mechnically ventilated patients... Great drug... rapid onset, rapid half-life, sometimes wicked hypotension. Code carts are always within arm's distance, MDs always present, and AmbuBags have been whipped out.

IV push vs. IV infusion... Intubated vs. non-intubated? Well, according to the powers that be, we are to "infuse via pump and titrate to sedation." This tagline has been followed by such terms as "JCAHO" and "Nurse Practice Act," striking fear in us all. Where the clear legal and ethical line is, I don't know... Obviously it's blurred enough that a best practice has not yet been established.:roll

..........many RNs who are now in anesthesia school or are new graduates, state that they didn't know what they didn't know when they were giving propofol as a non-anesthetist........

It's like taking a fully qualified Cessna pilot and dropping them into the cockpit of an F-16. Expect trouble.

Yes, propofol can be used in the unintubated person. It can be a scary thing however. You know how quickly it works and the apnea can be a scary thing. It has been used for sedation during spinal anesthesia, Monitored anesthesia care, and I know that it has also been used in oral surgeons office for surgeries without intubation. There is of course someone holding the head and maintaining the airway the entire time. Sounds like your group sparks some good discussions during your shift.