propofol

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do ya'll push it fo concious sedation?

rn29306. I would rather suck it up and take care of my patients if 2, 5, or 3 more years of school would close my eyes to the rest of the world. There is an old saying about an ostrich but I will not get into it here. Open your eyes and look at the number of cases done BY NURSES with 2, 3, 4, 5 years of college and 2, 3, 5, 15, 20 years experience and let's see what is dangerous and what is not.

There are still maps (and package inserts) floating around that show the world is flat...don't go on any cruises...

I am glad that someone, somewhere stepped up to the plate and decided to take that leap of faith and proved that this theory was wrong.

Someone (Drnaps) will do the same eventually. When someone opens their eyes.

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we are trying to get propofol (aka milk of amnesia) into our ed to sedate our ventilator dependent patients while boarding them when there are no icu beds. it is a great drug for just that, but we use versed for conscious sedation. ketamine is used for our cs peds patients...love that drug, works great, great induction time and shorter half life than other drugs...:rotfl:

while propofol is great for some intubated patients, we also use nimbex for those icu holds we have in our er... we use propofol for sedations, but we call them "moderate sedations" not "conscious sedations" our pediatric ed uses propofol on all their sedations.

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While propofol is great for some intubated patients, we also use nimbex for those ICU holds we have in our ER... We use propofol for sedations, but we call them "moderate sedations" not "conscious sedations" Our pediatric ED uses propofol on all their sedations.
And you understand nimbex is an NMB only, right? They still need something else for sedation.

No one has argued against propofol for ventilated patients. It's an entirely different issue ( or really a non-issue) than using it for "sedation" in the ER or GI lab, where we all know it's really used as an ANESTHETIC, hence the problem.

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rn29306. I would rather suck it up and take care of my patients if 2, 5, or 3 more years of school would close my eyes to the rest of the world. There is an old saying about an ostrich but I will not get into it here. Open your eyes and look at the number of cases done BY NURSES with 2, 3, 4, 5 years of college and 2, 3, 5, 15, 20 years experience and let's see what is dangerous and what is not.

There are still maps (and package inserts) floating around that show the world is flat...don't go on any cruises...

I am glad that someone, somewhere stepped up to the plate and decided to take that leap of faith and proved that this theory was wrong.

Someone (Drnaps) will do the same eventually. When someone opens their eyes.

What is rather amusing is that I have been where you and many others are currently. Then I have gone to where you and also many others have not gone also. I've been on both sides of the fence and I can see where both sides are coming from. Sadly, you and many others cannot see both sides, nor can you make an informed opinion.

Perhaps you are the ostrich..

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Just found out there is a propofol shortage in the UK, along with not having Diamorphine and a number of other drugs over the last year, all fun *ahem*

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And you understand nimbex is an NMB only, right? They still need something else for sedation.

No one has argued against propofol for ventilated patients. It's an entirely different issue ( or really a non-issue) than using it for "sedation" in the ER or GI lab, where we all know it's really used as an ANESTHETIC, hence the problem.

There are several issues in this thread... I KNOW THAT NIMBEX is NMB...

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Hi- new here- not as a nurse- as a patient. I am a IV Cert. LPN & lack just a few classes having my RN. (A little bit stand-offish regarding the whole medical thing as a profession at the moment as this year has been quite nerve racking) - we make bad patients don't we? :o )

Anyway, I was recently given Propofol as an anesthetic during MRI. When I first woke I was reciting the Lords Prayer out loud- which I found very peaceful- then when I realized I was still in "the tube" I began to yell "HELP!" (how embarrasing)... They told me that I had "stopped breathing everytime they turned up the med."

I had resection of a Carotid body tumor paraganglioma last year & we are now in the process of ruling out/finding the "Great masquerader of all tumors" a pheochromocytoma. These are very rare tumors & often hard to find with conventional tests.

My question...- I understand that sometimes patients who have pheos. are "hard to sedate" due to the often large amounts of circulating catecholimines. What does "stopped breathing" mean in terms of propofol useage? I did not have the energy nor will-power to ask after the MRI as I felt pretty groggy & out of it & embarrased at being such a big baby :o)

When a person "stops breathing" under propofol use, are they simply bagged backed to conciousness? There was an anethesiologist, Doc & RN there- so I felt all along I was in good hands. I did feel like they had the- "what the heck was that all about look" - a little on the confused side :o) Maybe no one has ever been religious & psychotic in the same few minutes in their presence? They were very kind just kinda quiet- I thought.

I have a question in to my Doc regarding this issue as I want to know what to tell anesthesiologists in the future how I reacted to the prop. other than "stopped breathing"

By the way- thanks to all the great nurses out there! I used to be a great nurse & hope to get that "drive" again once I get over this medical nightmare. I have had so many truly caring people take care of me- makes me proud of our profession. Keep up the good work! You ARE needed & appreciated- as a nurse I know we don't hear that enough!

Regards to all

NurseasPatient

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Hi- new here- not as a nurse- as a patient. I am a IV Cert. LPN & lack just a few classes having my RN. (A little bit stand-offish regarding the whole medical thing as a profession at the moment as this year has been quite nerve racking) - we make bad patients don't we? :o )

Anyway, I was recently given Propofol as an anesthetic during MRI. When I first woke I was reciting the Lords Prayer out loud- which I found very peaceful- then when I realized I was still in "the tube" I began to yell "HELP!" (how embarrasing)... They told me that I had "stopped breathing everytime they turned up the med."

I had resection of a Carotid body tumor paraganglioma last year & we are now in the process of ruling out/finding the "Great masquerader of all tumors" a pheochromocytoma. These are very rare tumors & often hard to find with conventional tests.

My question...- I understand that sometimes patients who have pheos. are "hard to sedate" due to the often large amounts of circulating catecholimines. What does "stopped breathing" mean in terms of propofol useage? I did not have the energy nor will-power to ask after the MRI as I felt pretty groggy & out of it & embarrased at being such a big baby :o)

When a person "stops breathing" under propofol use, are they simply bagged backed to conciousness? There was an anethesiologist, Doc & RN there- so I felt all along I was in good hands. I did feel like they had the- "what the heck was that all about look" - a little on the confused side :o) Maybe no one has ever been religious & psychotic in the same few minutes in their presence? They were very kind just kinda quiet- I thought.

I have a question in to my Doc regarding this issue as I want to know what to tell anesthesiologists in the future how I reacted to the prop. other than "stopped breathing"

By the way- thanks to all the great nurses out there! I used to be a great nurse & hope to get that "drive" again once I get over this medical nightmare. I have had so many truly caring people take care of me- makes me proud of our profession. Keep up the good work! You ARE needed & appreciated- as a nurse I know we don't hear that enough!

Regards to all

NurseasPatient

Anyone given enough/too much propofol (depending on your perspective) will stop breathing. That's not a side effect - that's an action of the drug.

You weren't "bagged back to consciousness". They took over your breathing for you until the propofol wore off enough that you could breathe on your own. Bagging you kept you alive, but really had nothing to do with your regaining consciousness.

This episode raises a big question. Why was this sedation-turned-general anesthetic necessary for your MRI?

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Adult patients that absolutely cannot hold or maintain position during MRI for whatever emotional or physical reasons should be IV induced and an LMA or OETT inserted, allowed to regain spontaneous respirations, and maintained with N2O / inhalational agents during the scan. This works amazingly well at our facility.

Personal opinion here, but only an idiot would attempt an MRI with IV agents that are known to cause apnea. How the heck can you monitor a patient's depth of anesthetic (which propofol is) and titrate it to effect with the patient buried in a tunnel? Those rescues must be mighty interesting, but I want no part of that as an AP and also I feel sorry for those patients. That is a poor technique to achieve an MRI and jeapordizes patient safety.

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Thanks everyone for your replies. I was sedated as I have had trouble with panic in the tube the last few times. This is a new behavior for me that I believe stems from all I have been through medicine wise this past year. Two surgeries on top of months & months of tests. Too many to name.

My Doc suggested sedation MRI as I started crying at just the mention of another MRI. They tried valium time before last & I still panicked & they brought my husband in too put his hands on my feet till it was over.

I have always been so interested & at ease in any medical setting- being the patient too many times this year has really stressed me out. It too makes me wonder if I'll ever get back to nursing as just the smell of a hospital at this point makes me nauseated.

Thanks for all of your replies.

Regards, NurseasPatient

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I have used propofol extensively in the ICU and ER settings and prefer it on intubated patients only. There is a greater variability on dosing effects and it does cause some very significant CNS depression. For simple relocations or reductions my experience with etomidate has been excellent, ketamine is pretty good but I just like the way etomidate wears off so quickly with such little residual effect. Narcotics and versed for longer CS procedures but they do require longer post sedation monitoring. The problem with morphine, dilaudid or fentanyl is when you remove the painful stimuli ( ie: set that femur fx) patients can suddenly go out as all the narcs catch up. Our CS is always done with an RT, the resident performing the procedure and attending supervising so we are always well covered for oversedation, though it still causes a massive adrenaline dump in me. Propofol for CS would make me very nervous.

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Thanks everyone for your posts. I don't have much knowledge of anesthetics & their uses- am learning more from all of you & really appreciate all of your expert input.

I really don't understand why they would go out to the waiting room & get my husband & scare the crud out of him saying "she stopped breathing" since its a normal occurence with Propofol. Of course none of you can answer that question. Then when I woke they told me the same. Won't be letting them use that in the future for sure!

Do any of you know what is best for short-term MRI sedation? One of you posted what your facility uses- gonna read up on that too.

They used Versed for my arteriogram to check my carotid (where the tumor was wrapped & strangulating) & I yapped thru the whole procedure- the Doc actually had the nurse give me more Versed & it still did not phase me. (I know that Versed is used in cases where the pt. needs to stay awake). They told me they were using it so they could give me commands but that I should not recall anything that happened- I remember ever single thing about the test- which I found very interesting but a little disturbing too- watching the catheter go up thru there & actually seeing the tumor thumping on the screen- yeek!

They used versed on me a few years ago during a colonoscopy & I did'nt remember squat after the scope. It was done at the hospital I worked at & they were all pretty tickled when I came around- Lord knows what kind of crazy things I said- lol

When a person has increased circulation of catecholamines I imagine it takes more of any drug to chill them out.

Thanks again for all of your responses- trying to learn what I have issue with or don't do well with so we know what to use in the future.

Regards to all,

NurseasPatient

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