propofol

I just do not understand why anyone would desire to take on this kind of risk. You risk so much and it is just not worth it. Send in the CRNA please.

I just do not understand why anyone would desire to take on this kind of risk. You risk so much and it is just not worth it. Send in the CRNA please.

By the way that some of these people are posting, I don't think that they think IT IS an additional risk. :uhoh21:

Hi- this is not related to Propofol (was not sure where to post it). I think it is worth posting since so many anesthesia folks seem to be reading in this area. This gives some insight into anesthesia issues, more specifically those issues as they relate to a patient with Pheochromocytoma. I'm sure this has been covered in school for you folks but as these tumors are so rare I thought you all might like to read about one patient's experience with anesthesia in the presence of a pheo as a sort of refresher course. Best to all & I really do appreciate everyone's insight into my issue with Propofol. To those of you who are practicing within the realm of your training & trying hard to save lives by encouraging the others to do the same!- YEAH YOU!

http://www.clinmedres.org/cgi/content/full/2/1/59

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. Cathy, RN, BSN - Cleveland

Sorry, Cathy, but you need to read up on the definition of conscious sedation. A patient whose only response is grimacing or withdrawal to pain is deeper than conscious sedation. Etomidate is a general anesthetic, is labeled as such, and is included in the category of drugs that should not be administered by those without training in managing & rescuing from states of general anesthesia.

Lou

We frequently use Propofol as a cont. drip on our vented Pts. Also occasionally use it at low dose if Pt. not vented. Drs. do IVP. We do frequently use IVP Versed and occasionally as cont. drip.

Great to use on neuro Pts. since it is so short acting. We stop Propofol drip every 8 hrs. to judge Pt. neuro status.

MidnightSn1

:penguin:

The general standard seems to be that Propofol IV push is limited to Anesthesiology. Propfol may be used in the ICU setting for intubated patients only, and as a continuous infusion; guidelines for drug withdrawal and CNS evaluation must be in place.

Prior to working in the ER, I participated in CS for cardioversions on tele. We used versed and some form of pain med like fentanyl or demerol. The pt's NEVER remembered the "jolting" procedure and seemed very comfortable upon waking. It usually took them ~30min to wake up completely. And if they had problems waking, we could always reverse them with romazicon or narcan. I have never used a paralytic or general anesthesia drug for CS. We routinely give etomidate for intubation, but only intubation. Who wants to bag a pt for 7 minutes when there are more appropriate drugs to use for CS?

I just got a lot of flack from a doctor because he doctor ordered propofol for moderate sedation. I showed him the hospital policy stating it can only be given with an anethetist present.He responded with 'we have done it here in the past". I held my ground and said I am only following policy and if they wished to do it they can do it without me in the room. He caved and the pt recieved nothing as a result..

I found out from the supervisor later had I caved I could have been in a lot of trouble if I had given the propofol. It pays to know your own hospitals policy and follow it to the tee you cannot go wrong.

I've seen one of our CRNA's push it like it was a flush, (with a succ chaser). Generally though in our ED it's the follow up to Versed after an intubation.

we usually use versed and a narcotic for cs.propofol is only used for vented pts in my er.the only time i ever pushed it was in icu on vented pts when we were starting a drip.i have never seen propofol used for cs.

Our hospital policy is that propofol can only be administered to intubated pts. Pushes can only be given by anesthesia staff.

For conscious or moderate sedation used for reduction of fractures or dislocations we use versed alone or with a narcotic. Pts must be on a cardiac monitor with intubation setup at the bs.

Angel

dumb question........since my icu days were so long ago and we did not use prop drips/occasional boluses.........even if the patient is ventilated are u not concerned about the other overall concerns mentioned, like pt's cardio status, resp status, etc.? that seem to be concernes with the non-vented patient?

anesthesia only give prop in my setting(pacu) and not sure if they use drips in icu and who or how they are managed....and we use versed/fentanyl for conscious sedation in er which i left 2 years ago and i used ketamine once on a ped conscious sedation and it is scary stuff. i think i made the dr give it.:trout:

very informative thread too btw.