propofol

paranoidnurse · Dec 2, 2005

we use it in ER for conscious sedation for ortho stuff like dislocated hips and elbows. Seen it occassionally for closed reductions wrists and ankles. The docs push it. We keep ambu and intubation equipment set up at bedside but so far have not had to use it. (knock on wood) The patients usually wake up within 5-15 minutes and never even know they were asleep. Otherwise we just use the drip on intubated patients. Sometimes we have to hold them in ER 6-8 hours before an ICU bed becomes available or they can be transferred out.

longtimeRN · Dec 2, 2005

I work in a neuro-trauma unit. We frequently push propofol on vented pts. for procedures, and also for emergent intubations. We'll only push it on non- tubed pts. if the doc is in the unit. Where I worked last, running an infusion over 10mcg/kg/min was considered anesthesia, which we weren't supposed to do. Like THAT was real effective on big pts.!

sjrn85 · Dec 2, 2005

Now that's an incredible oxymoron - "slightly deeper conscious sedation". Propofol in the hands of non-anesthesia providers, with the exception of ventilated patients in the ICU, is dangerous - period.

LOL! In total agreement here!

ROSETTE · Dec 3, 2005

Ithink using Propofol in my ICU is beneficious because the pacients when they use it , wake up faster than using other drugs and they begin the weaning the mechanical ventilation ,also lowers the complications, but Propofol is very expensive.

SnowymtnRN · Dec 4, 2005

we use it quite a bit in our ER. about 50/50. I agree with whoever said the patients seem to recover quicker with fewer side effects. It just depends on the patient, tolerance, size, injury, etc..etc...i've pushed it several times and never had a problem with it. however i've not ever done it without a MD at the bedside. Why would you ever push anything for conscious sedation without a doc at the bedside? And for that matter, we use a CS room where there's intubation equipment/BVM, etc...on hand.

I don't see what the big deal is to be honest. If its legal in your state according to the BON, and you read up on the drug and have a doc in the room, then i'm ok to give it.

azrn22 · Dec 4, 2005

We bolus our vented pt's with propofol, but it is my understanding with propofol that anything over 100mg is anesthesia and a Dr has to push, for legal reasons. We as nurses are not anesthesiologists. I think the concentration is 10mg/ml, so 10ml is anesthetic doseage.

Let me know if I am off base here.

CRNA70 · Dec 4, 2005

Continuous low=dose infusions of Propofol are common the ICU Setting. What must be understood is that Propofol is a GENERAL ANESTHETIC in bolus form and high-dose infusion. Professionals must be trained in airway management (most staff RNs are not), and intubation. Therefore, in my opinion, other than the low-dose ICU infusion, it should be managed by anesthesia providers (CRNAs/anesthesiologists) who can rescue and manage the airway. This is a patient safety issue.

rnmom3153 · Dec 7, 2005

Continuous low=dose infusions of Propofol are common the ICU Setting. What must be understood is that Propofol is a GENERAL ANESTHETIC in bolus form and high-dose infusion. Professionals must be trained in airway management (most staff RNs are not), and intubation. Therefore, in my opinion, other than the low-dose ICU infusion, it should be managed by anesthesia providers (CRNAs/anesthesiologists) who can rescue and manage the airway. This is a patient safety issue.

:yeahthat: :yeahthat:

I've recovered patients in pain management, but anesthesia administered it. I've seen it used on vented patients in the unit as above for sedation. Great drug! Never had a problem. Knock on wood! :Santa1:

qanik · Dec 8, 2005

I think you folks are missing one main point- the start of this thread was asking for conscious sedation- the definition of conscious sedation is " a medically controlled state of consciousness in which PROTECTIVE REFLEXES are maintained. This patient retains the ability to maintain the airway and CAN RESPOND appropriately to physical stimulation or verbal commands such as open your eyes or squeeze my hand" This is the definition provided by the American association of nurse anesthetist and the american society of anesthesiologist. Look up legal cases involving conscious sedation and one common theme stands out- If the patient stopped breathing or was unresponsive to commands then they were beyond conscious sedation and whoever was involved is going to be liable if a poor outcome is involved. Having worked in the ed and icu and flight world for years I have seen exactly what you are describing the brevital bolus and the brief knock out that comes with it to relocate a ortho injury- not conscious sedation! The propofol bolus breif apnea perform the procedure and done- not conscious sedation! After attending CRNA school and actually seeing the defintions of conscious sedation, deep sedation and general anesthesia you realize when a doc or crna comes to administer the drug it has nothing to do with reimbursement issues it is purely a legal and competence issue to protect you and the hospital.

Hopes this helps

Qanik

pinknuts · Dec 9, 2005

In our ER we use it all the time and there is no drug I would rather use. The half life of the drug is so short that if patient becomes too sedated you can easily bag the patient until it clears enough for them to breath on their own. I love my milk of amnesia!! Obviously the goal of conscious sedation is for the patient to remain conscious, but with any meds you can never be sure how a patient will react to a med until it is given. IF this is done in an ER setting then there is someone in the room with you who is able to manage an airway.

CRNA70 · Dec 9, 2005

By definition, then, propofol should not be used if the intent is conscious sedation. RNs can administer conscious sedation--you and I as CRNAs or our anesthesiologist colleagues can administer the deep sedation and general anesthesia with propofol by right of our advanced training and certification. I disagree with the notion that staff RNs are pushing this stuff. (This is not meant as any disrepect to our RN colleagues--it is a safety issue.)

qanik · Dec 9, 2005

CRNA 70 I totally agree. Pinknuts- While in CRNA school I did a project on conscious sedation and the legal implications. You may have that cowboy mentality that if they stop breathing just bag them but you have obviously NOT done conscious sedation if they stopped breathing in the first place and I will tell you if there is a bad outcome you will have NO defense legally because you were NOT doing conscious sedation.

QANIK