propofol

WE are not permitted to use Propofol for CS, only fentanly and Versed.

I wish we could use it. We used it in the ICUs

OK, I see that you are one of those types who is incapable of having a productive discussion with someone who thinks or is used to doing things a little differently than you. You assume that I'm cocky and incompetent just because I'm comfortable doing something that you think I shouldn't be? That's a pretty ballsy and closed-minded assertion considering how little you know about me and my experience.

No, I didn't miss that part of the insert. If I based my entire practice on the warnings listed on drug inserts I would never give anything to anybody.

More than one lawyer, more than one medical director, more than one anesthesiologist, and more that one state board of nursing disagrees with your legal interpretation of that statement. I'm not the only non-anesthesiologist in the world who uses propofol and is comfortable with it

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raising hand.....

on the package insert of phenergan it warns that the pt may have a seizure. if the pt has one, am i lliable for that?

on the package insert of tpa it warns of bleeding. if the pt develops an ich, am i laible for that too?

all drugs have their risks. i have used a lot of diprovan in the er on dislocated shoulders. the drs are too busdy pulling and tugging to watch the airway. all er nurses have acls and are more than competent to recognize airway demise. sure pts may need to be bagged sometimes. but when done properly, a great sat can be maintained, and intubation avoided.

additionally, i teach acls and i always tell my new interns not to panic if they can't intubate the pt. but to NEVER EVER forget to bag the pt properly.

i don't think crnas are the only nurses on earth who can handle a compromised airway. and to say 'well, rns can't intubate' is not a great arguement either. we can't insert guidewires for pacemakers either, but we sure as heck can push lopressor and know when heart blocks require the drs butt to intervene! the same with airway. if we can't recognize apnea and know we then need more intervention from the doc, then we're a pretty pathetic bunch now huh??

Right On, thats right

We use Etomidate often where I work (in the ER) for sedation or quick procedures, but I often hang Propofol to keep patients sedated while on a vent or during a procedure where we don't expect to bring them out of it -rather xfer them to the unit. So I use it often, but not in the CS format..

What do you all think of this? November PET CT- lungs clear as a bell... March PET CT- atelectasis ALL LOBES of lungs, developed 4+ pitting edema to extremeties AFTER January Propofol "issue" in MRI? Hmmmm... Now I have to take Aldactone TID to keep the swelling @ bay & wheeze intermittently when lying down... Wonder if that is related to NOT BEING INTUBATED WITH AN ANESTHETIC ADMINISTERED & having to be bagged back? Kinda makes a person think, huh? ONE STRIKE I DID NOT NEED AGAINST ME @ THIS POINT- OR EVER FOR THAT MATTER... Just some FYI in case anyone wonders what the patient might think of being given Propofol w/out intubation... I keep thinking... this was to help me relax...

:smackingf

Policies and procedures are in place for a reason. They are put in place to have something to fall back on. In the event of a complication did the nurse follow proper protocol. If she \he did not then he/she is liable for malpractice. You can play russian roulette with etomidate and propofol but remember it only takes once. True you probably could give these meds without incidence all your carreer but you could also give it once and harm a patient and since it is not within protocol to give this as conscious sedation and not within the scope of practice, you can lose your licence and thus career. The bottom line is the CRNA can give it the RN cannot.

Great post tridil2000. Well put. I,m sure you will NOT be popular on this thread for long. Hang in there.

hi all do you know something interesting about propofol . Propofol is act on libido and there are incidence when a male patient try to hold and kiss female nurses while coming out of propofol sedation

Just a side note. My husband has a very strange side effect to propofol as well as other asesthia agents. He is a "breast man" at heart. The first time he had surgery it was at a very small hospital where I was a supervisor. I was sitting outside Recovery when I heard a nurse scream and yell"Debbye, get in here!" :chair: My husband, still unaware of his surroundings just wanted to hold her breasts. : For his second surgery there we were prepared and I was in the recovery room when he came out. He's a big man 6'4" and about 260# but I have no trouble controlling him. When we moved to a metropolitan area he had some dental work done under sedation. I warned this tiny tiny dental assistant of potential problems and she just brushed me off. (You know the attitude that "That Nurse" thinks she's special") Lo and behold I heard that same scream and she rushed out to get me. He has had 2 further surgeries at my current hospital and they all know me well there and took no chances. I'm always at his bedside when he wakes up. Have to admit It's a little embarrasing :imbar but he truely doesn't remember any of it. You can tell when it wears off because he goes from a very happy feely person to a cranky "Get me out of here" man. So far it has only been hernia's and shoulder repair, he always refuses to spend the night.:trout: What can I say.. He's my man:kiss

Thanks for sharing Debbye. I needed a good chuckle this morning.

So anyway, instead of just repeatedly telling us non-anesthesia people things like "you shouldn't be using this drug....it does things you aren't aware of....you don't even know what you don't know....you'll never get it.....read the package insert", why don't you instead try to have a little more respect for our capability to understand and educate us a little on what it is that we don't know?

In other words, why, specifically, shouldn't we be using the drug?

I know I'm beating a long dead horse, but it appeared that, even though this question had been answered in several different posts, it was never directly addressed. So, here is your answer:

1. Airway issues: ACLS is not the be all end all where airway is concerned. More than one nurse here has expressed the idea "so what if they stop breathing? I can always bag them!" OK, but what if you CAN'T ventilate the patient with a bag and mask? What do you do now? Hope the propofol wears off before the patient suffers an anoxic injury? Try to tube the patient, because after all it wasn't that hard on the dummy in ACLS? Rest assured, intubating a real patient bears only the slightest similarity to intubating a dummy. And yes, there are patients out there that, try as you might, even with an oral airway, you can not ventilate with a mask. In my practice, I have found those same patients can also be difficult intubations. So your ER doc, who does one whole intubation a night (at most) is out of his/her league. Bottom line is that this is NOT a conscious sedation drug, it is a general anesthetic. As such, you must be prepared for the airway issues caused by general anesthetics.

2. Cardiovascular issues: Propofol can have some pretty impressive cardiovascular effects. Therefore, before I ever push the drug to induce anesthesia, I make sure there are certain other drugs readily available (meaning within arms reach). Some of these drugs, like atropine, you probably have in the ED. Others, such as neosynepherine and ephedrine, you probably don't have, and even if you do, you don't know the appropriate doses to give IV push. You are giving a drug but are wholly unprepared to deal with the potential side effects. That alone should cause you a great deal of discomfort.

3. Legal/Liability issues: It doesn't really matter what your hospital policy says. Doesn't really matter what the BON has to say either. Consider the following situation: You give propofol to a 50 year old male with a shoulder dislocation. He stops breathing, so you grab the bag/valve/mask. Uh oh, you can't move any air! While all this has been going on, the monitor takes your patient's pressure, and it's 60/38, with a heart rate of 122. Now what? Your doc rushes to the head of the bed, all the while ordering epi to get the patient's pressure up. He gets out the scope, and can't see a thing. Now, you are in a can't ventilate, can't tube situation, and the tone from the sat monitor is about an octave lower than you started with and falling like a rock. Meanwhile, you have given the epi to get the pressure up, and it works. Unfortunately, the patient also had a previously unknown cardiac problem, and his ST segment is rising rapidly. The situation has rapidly spiraled out of your control, and the patient who came in with a dislocation now has had an MI and possible/probable anoxic brain injury. (Assuming, of course, the patient is still alive.) Guess where you are going? To court. Once there, the plaintiff's attorney provides the package insert to the jury, who are not medical professionals, and points out the paragraph concerning who should be giving the drug. He then points out that your ER doc, who ordered the drug, has no formal training in anesthetics. He also points out that you don't either. You counter "I am ACLS certified, that's good enough!" The attorney then asks you to find and point out in the package insert where it says the drug may be given by any medical professional who is ACLS certified. Of course, you can't. Do you know what your next action will be? The hospital, your ER Doc, and you will all get out your checkbooks, and each of you will sign a check, allowing the plaintiffs to fill in the amount. Its even possible that if you have malpractice insurance independent of the hospital, they may tell you you are on your own, because you were administering a drug the manufacturer says you are not qualified to give.

4. In brief, do you think you could walk into an OR and administer general anesthesia? If not, why do you think you can do so in the less controlled, less well prepared ED?