propofol

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do ya'll push it fo concious sedation?

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

The reason you stopped breathing was that you received TOO MUCH propofol. This is exactly why anesthesia providers do not want propofol used by nurses in GI labs and ER's. If the person giving you propofol for your MRI was actually an anesthesiologist, a CRNA, or an AA, they did a pretty poor job. The only reason I doubt this was someone from anesthesia doing this is that I can't imagine an anesthesia provider giving you too much propofol, and then going out and telling your husband that you stopped breathing. It generally isn't a big deal if someone from anesthesia gives you too much propofol because we can easily handle airway and breathing issues. That is usually not the case with someone outside of the anesthesia field. The fact that the person sedating you seems surprised by what happened and felt the need to tell your husband strongly indicates to me that they did not know what they were doing and were not an anesthesia professional.
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Specializes in ICU.
The reason you stopped breathing was that you received TOO MUCH propofol. This is exactly why anesthesia providers do not want propofol used by nurses in GI labs and ER's. If the person giving you propofol for your MRI was actually an anesthesiologist, a CRNA, or an AA, they did a pretty poor job. The only reason I doubt this was someone from anesthesia doing this is that I can't imagine an anesthesia provider giving you too much propofol, and then going out and telling your husband that you stopped breathing. It generally isn't a big deal if someone from anesthesia gives you too much propofol because we can easily handle airway and breathing issues. That is usually not the case with someone outside of the anesthesia field. The fact that the person sedating you seems surprised by what happened and felt the need to tell your husband strongly indicates to me that they did not know what they were doing and were not an anesthesia professional.

:yeahthat:

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Nurses at my facility are not allowed to push propofol because it is considered anesthesia and deep sedation. If a patient needs CS with this drug, the CRNA comes to the ED to administer. This is great because they are then responsible for patient care while there.

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Weird- the nurse who got me prepped- started my IV etc... actually brought a guy over & introduced him "this is your anesthesiologist" & also introduced a "Dr" who would be present during the procedure.

The nurse later said "we had to keep upping & upping the dose to get you to go under & thats when you stopped breathing." She seemed really surprised that it took so much. Actually they all looked a little flipped out to me when it was all done...Of course I was groggy so maybe I was just flipped out from hearing I had stopped breathing. I really felt pretty out of it for the rest of that day & night which is probably normal..

Anyway- it was obviously a goof & after reading everyone's comments here, it is all the more clear to me that Propofol is not a good med to give someone who's in a chamber. Def. not for me anyway.

When I asked my Doc about it he said "in the absense of increased catecholamines anesthesia would not be contraindicated"- my 24 hour urine was not back yet & still isn't- takes forever! So I am still waiting to see if the levels were high so we can take the next steps to find this hidden tumor which we believe is what is making my B/P run as high as 220/110 & as low as 80/45 (my norm is around 90/70).

I wasn't trying to get anyone to un-do what was done or even complain about what happened. I just wanted him to know that this is obviously not a drug they should use with me in the future & wanted to point to the fact that persons with high catecholamines are harder to sedate. (the large amount of propofol it took is just further evidence to me that my levels were high)...

Thanks again for everyone's input.

Will be sure to make it clear that I don't want them to use Propofol on me in the future!

This link contains an article written by a mother of a child with pheo. & the child's similar issues with sedation, thought it might be of interest to anethesiologists.

As these things are so rare most people won't encounter a patient with one but in case, it would be good to read.

http://www.vhl.org/newsletter/vhl2005/05dbpheo.htm

Regards, NurseasPatient :nurse:

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We use Etomidate for conscious sedation. The bad part is it causes respiratory depression if not calculated to the ml and even worse, there is no reversal agent. The good news is it's half life in only about 7 minutes and I can bag anyone for that long if sats drop. Cathy, RN, BSN, Cleveland

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We use Etomidate for conscious sedation. The bad part is it causes respiratory depression if not calculated to the ml and even worse, there is no reversal agent. The good news is it's half life in only about 7 minutes and I can bag anyone for that long if sats drop. Cathy, RN, BSN, Cleveland

As a staff RN, why allow yourself to get in this position in the first place?

You are delivering a general anesthetic to an unintubated patient, not for conscious sedation, but to appease an MD that prefers UNCONSCIOUS SEDATION. In your post you even acknowledge that:

- the dosages are exacting

- respiratory depression

- no reversal agent is available

What you are doing is performing general anesthesia. A common misnomer amonst staff RNs (I can say this because I used to be one) is that "I can bag anyone and get the sats back up". WRONG. WRONG. WRONG.

The OR is about control. Things are controlled there. You are in a chaotic environment without control doing jobs that are outside your scope of practice, regardless of how many 'inservices' you attend. Ambu bags have no compliance to them. In the OR, I can tell both by feel and pressure if the O2 I am delivering via bag ventilation is going into the trachea and ventilating the lungs or is going straight into the esophagus and blowing up the stomach.

To assume

...7 minutes and I can bag anyone for that long

displays undereducation and a combination of ignorance or blind arrogance.

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Sorry, I disagree with the concept of unconscious sedation and etomidate. Yanking on a dislocated shoulder ALWAYS invokes a grimace with etomidate, therefore, there is some consciousness going on. The dosing, while being exact, also is going to effect different people differently. Just because there is no reversal agent does not make the drug any less effective - only better practioners, that are able to recognize the beginnings of possible problems. I personally like the drug because of the amnesic effects combined with the sedation. Not even OR can predict a person's response and control the situation when a person has an unexpected response to a med.

What does having a feel for the AMBU and ventilating v. blowing up the belly have to do with the sedation? I'm not saying tubing someone, I'm just saying that the half-life is short, which can be reassuring knowing that the should is reduced and the pt. might have had an unexpected reaction to the medication. Cathy, RN, BSN - Cleveland

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Sorry, I disagree with the concept of unconscious sedation and etomidate. Yanking on a dislocated shoulder ALWAYS invokes a grimace with etomidate, therefore, there is some consciousness going on. The dosing, while being exact, also is going to effect different people differently. Just because there is no reversal agent does not make the drug any less effective - only better practioners, that are able to recognize the beginnings of possible problems. I personally like the drug because of the amnesic effects combined with the sedation. Not even OR can predict a person's response and control the situation when a person has an unexpected response to a med.

What does having a feel for the AMBU and ventilating v. blowing up the belly have to do with the sedation? I'm not saying tubing someone, I'm just saying that the half-life is short, which can be reassuring knowing that the should is reduced and the pt. might have had an unexpected reaction to the medication. Cathy, RN, BSN - Cleveland

As ALWAYS - another example of someone thinking they know a lot more than they do.
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As ALWAYS - another example of someone thinking they know a lot more than they do.

Please explain.

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Sorry, I disagree with the concept of unconscious sedation and etomidate. Yanking on a dislocated shoulder ALWAYS invokes a grimace with etomidate, therefore, there is some consciousness going on. The dosing, while being exact, also is going to effect different people differently. Just because there is no reversal agent does not make the drug any less effective - only better practioners, that are able to recognize the beginnings of possible problems. I personally like the drug because of the amnesic effects combined with the sedation. Not even OR can predict a person's response and control the situation when a person has an unexpected response to a med.

What does having a feel for the AMBU and ventilating v. blowing up the belly have to do with the sedation? I'm not saying tubing someone, I'm just saying that the half-life is short, which can be reassuring knowing that the should is reduced and the pt. might have had an unexpected reaction to the medication. Cathy, RN, BSN - Cleveland

This post is scary. Having an ER background before starting CRNA school, I can relate to wanting to get the procedure as quick as possible without alot stress, but if it takes a pull on the shoulder to get the patient to "grimace", you've gone past conscious sedation (technically). Etomidate does not provide pain relief and it makes patients puke alot afterward, so comfort is out the window in this argument. Fentanyl and versed are a great alternative to a intravenous induction agent.

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Specializes in ICU.
Please explain.

I don't think that his post needs any explanation. He pretty much said it like it is. I don't understand you people. PROPOFOL IS GENERAL ANESTHESIA!!!!!!

An RN is not qualified to administer general anesthesia, I don't care how good you think you are. I am so glad that I don't work with some of you folks because you outright scare me.

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Please explain.
Gee, where to begin?

First - there is no such thing as "unconscious sedation". That's called general anesthesia.

Second - a grimace is a response to a painful stimuli and has no relation to consciousness.

Third - whether a drug is reversible or not does not determine it's effectiveness. It does however help when amateurs who think they know better get in over their heads.

Fourth - you don't understand lung compliance and how an experienced anesthesia practitioner can tell the difference by feel whether or not they're moving air or not when bagging someone.

Fifth - you don't understand the concept of half life anyway, but just because a drug has a short half life doesn't mean that it's not more than long enough for your patient to die in front of your eyes.

In the OR, and in the hands of anesthesia providers, we deal with sedation/anesthesia, airway management, "unexpected reactions", etc., on an ongoing basis, not just occasionally in an ER. And yes, we can predict the reaction of any of the drugs we use in the vast majority of our patients and can easily and calmly handle any issues that arise. Such is not the case with an ER nurse.

Ever wonder why things like airway management for us are routine - and ANYWHERE else in the hospital, it's an emergency. It's because WE'RE the experts - you're not. Anesthesia is best left to the experts, not the clueless amateurs that have no idea what they're talking about.

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