propofol

tridil2000, MSN, RN · Sep 8, 2006

what if the pt iwas allergic to eggs and you didn't know that? do you have
we have a kit too. and i have never seen a board certified er doc or an intensivist in 20 years put pressors before fluids. see my post above about tachyarrythmias etc. you would really do that? push neo directly for a sbp in the 60s and a heart rate of 122? do you worry about throwing the pt into svt of 160 or so? do you have adenosine ready in 3 syringes? 6/6/12? do you wonder about inducing v tach? do you compare the mean to your baseline?? now you've got bigger problems!!!
Actually, Neosynephrine causes a decrease in heart rate, not an increase. Neo would be a great choice for a patient with a low blood pressure with a high heart rate, especially if it was due to the vasodilating affect of propofol. Neo, although it has other actions, works primarily by vasoconstriction. This vasoconstriction causes an increase in afterload and venous return, which results in reflex bradycardia. So yes, in anesthesia, we routinely push Neo 100-200 mcg at a time for hypotension that occurs after induction. And yes, we also give fluid, etc...

at the time, we were discussing iv bolus epi as a first line choice for an allergic reaction.

AmiK25 · Sep 8, 2006

at the time, we were discussing iv bolus epi as a first line choice for an allergic reaction.

I realize that at one point you were discussing pushing epi for anaphylactic shock. However, in your post, you did not say epi, you said neo and I don't think you were still discussing anaphylactic shock because obviously, you do push epi, regardless of whether the patient is tachycardic or not (which they should be if it is anaphylaxis). I think that instead of learning from this thread (which we all have), you just cannot admit that there might be something you don't know and you have an excuse for everything. We are all learning on a daily basis, whether it be in the OR, ER, or ICU and we should all be able to admit that there are things we don't know. I'm not trying to be rude but that is my honest opinion.

auto5man · Sep 9, 2006

Going back to the original question....using diprivan/propofol for conscious sedation. At my hospital it is against policy to use unless a patient is intubated, only anesthesiologists can administer boluses b/c it is considered induction, and it should only be administered in a central line. That being said, ER nurses are pragmatists, and if I don't have a central line at the moment and my freshly intubated patient is thrashing about but doesn't have a central line, yes I will administer diprivan. I will not use a line someone else started though without carefully checking it first and prefer not to use a vein distal to antecubital as the drug is tissue-toxic. Infiltration can cause severe tissue damage.

There seems to be much confusion about this conscious sedation issue with MD's. I have been asked many times by MD's, without fail one who is a specialist in the ER on a consult (not one of the regular ER docs in other words) who asks me to give a diprivan bolus for a procedure. They seem surprised when I tell them I can't b/c its considered anesthesia at my hospital and out of the scope of my practice (and theirs too if they are not an anethesiologist, but I don't say that).

Regards,

David

eprnlittlerock · Sep 9, 2006

I work in an EP lab. We are going to do a study on the advantages of propofol vs. versed and fentanyl. propofol has such a short half-life vs. the other. For cardioverson, ICD check and in addition to versed and fentanyl(for pt with difficulty providing adequate CS). An abstract was presented at HRS last year, Can anyone help us with some information or input?

passgasser · Sep 9, 2006

I work in an EP lab. We are going to do a study on the advantages of propofol vs. versed and fentanyl. propofol has such a short half-life vs. the other. For cardioverson, ICD check and in addition to versed and fentanyl(for pt with difficulty providing adequate CS). An abstract was presented at HRS last year, Can anyone help us with some information or input?

Personally, the EP lab is the last place I'd use propofol for conscious sedation. First of all, the sedation provided by the drug is anything but conscious. More importantly, propofol has significant cardiovascular effects. It can cause serious hypotension from vascular dilation. It can also cause cardiodepression. Do you really want to use this in a cardiovascular lab?

Again, best leave the general anesthetics to those who use them every day.

eprnlittlerock · Sep 9, 2006

We use propofol for cardioversion and ICD checks. With the short half-life, the pt is awake with 2-3 minutes after in med. Small amounts(50-100mg, depending on the pt size and weight) should have the pt comfortable and maintaining the own airway. With versed and fentanyl(both in large amounts, depending on the pt size and weight) have such a long half-life, that they have to be nomitored much longer. How would you go about sedating these pt.? Even if the pt. needs more sedation ie. long a-fib ablation, small amounts of propofol can be very helpful and maintaining the pt. own airway. Do have have any other seggestions to make for these situations?

rn29306 · Sep 10, 2006

Our EP lab, when doing implanted debifs, does their own sedation with EP RNs doing fent / versed CS and the surgeon uses liberal amounts of local in the pocket. For testing and sensing, they call us for the propofol administration and we set up shop (ie, ready to intubate). We stay with patient until they are awake and then we leave.

We also do the CV with propofol and are completely set up for those as well.

eprnlittlerock · Sep 17, 2006

Do you give large amounts of propofol? Less than 10mg?kg? Have you had to intubate your pt. in an emergant situation? How much versed and fentanyl do you have to give to do your ICD testing? I have not heard of a SRNA. What is an SRNA? I don't mean any disrespect!

skipaway · Sep 17, 2006

I have not heard of a SRNA. What is an SRNA? I don't mean any disrespect!

SRNA=Student Registered Nurse Anesthetist

quecon · Mar 20, 2007

Does anyone anywhere have a competency program in place for nurses who use propofol?? In our hospital, nurses can administer an IV drip to intubated patients only. A few ED docs have wanted to give it for concious sedation, but our anesthesiology dept will not allow that. With propofol. there is a fine line between concious sedation and deep sedation. All of the literature I've read calls for nurses to be "certified" (thru competency at least) in the use of Propofol even if it is for the intubated patients. There is even a question as to whether our malpractice insurance policies will cover us if nurses are giving anesthetic drugs. Please, if anyone has a competency program let me know.

AnnieOaklyRN, BSN, RN, EMT-P · Mar 21, 2007

They use it in the E.D. I work in in NH, however if the the patient is not intubated an MD or CRNA must push it per the NH BON

phiposurde · Mar 21, 2007

In my ER we use it exclusively for CS with Fentanyl. Our protocol require we have an RT at the bedside and cardiac monitoring. Since we usually do it in the minor side we bring the crash cart at the bedside. We used to give it but the doctor realize the could charge for it, so guess who give it now?

Great drug, not many side effect and the go home in a very short while!!!