propofol

I wouldn't trust the doc I work with to have to be responsible for intubating a pt.; I'd be willing to bet it's been many years (maybe decades) since he's done it. No way would I want him to be responsible for intubation.

I guess right now it's up to the individual nurse until the FDA changes the regs. Not for me, that's for sure.

Our ED docs intubate constantly in the Level 1 where I work. When I work a twelve hour shift we usually end up with at least 4 intubations. I would never push the drug in an office setting where I know the office physician has never intubated for years, but in a level one trauma center, I feel comfortable.

There are several alternatives to propofol here. What about versed, etomidate, ketamine, fentanyl, depending on the patient and what you need it for. Propofol should be reserved for intubated head bleeds and/or traumas where quick sedation and short half life are a priority.

There are several alternatives to propofol here. What about versed, etomidate, ketamine, fentanyl, depending on the patient and what you need it for. Propofol should be reserved for intubated head bleeds and/or traumas where quick sedation and short half life are a priority.

I'm sorry to disagree...times have long passed since "anesthesia providers" can lay sole claim to providing these things without their consumate knowledge. Many level I trauma centers and large facilities ROUTINELY use propofol and these other mentioned medications for sedation and/or anesthesia. Done under the proper monitoring and under the supervision of trained physicians and nurses, these things can be administered responsibly and safely. Anesthetists are not necessarily the only people to provide it. So I disagree, and so do dozens of ERs and critical care units across the country.

I'm sorry to disagree...times have long passed since "anesthesia providers" can lay sole claim to providing these things without their consumate knowledge. Many level I trauma centers and large facilities ROUTINELY use propofol and these other mentioned medications for sedation and/or anesthesia. Done under the proper monitoring and under the supervision of trained physicians and nurses, these things can be administered responsibly and safely. Anesthetists are not necessarily the only people to provide it. So I disagree, and so do dozens of ERs and critical care units across the country.

You may disagree with JWK, but more than 20 professional nursing organizations, the AMA, ASA, AANA, and JCAHO disagree with YOU. Current clinical practice guidelines for the provision of procedural sedation state that non-anesthesia providers should not be administering any drug labeled as a general anesthetic, including propofol, ketamine, brevital, etomidate, or STP, for procedural sedation. Joint Commission, though they don't specifically address particular drugs, says that if YOU are pushing any particular drug for procedural sedation than YOU better be able to rescue the patient from any level of sedation, including deep sedation or general anesthesia, that may develop. YOU. Your statement regarding reserving propofol for head bleeds and traumas indicates that you do not possess the knowledge necessary for administering these agents.

I'm not trying to flame you in any way, pinktermite, but I have done considerable reading on this subject as it is the crux of my master's thesis. This topic always brings out the heat from folks, and it's difficult for me to understand why. It's not about questioning anyone's clinical skills really, it's about providing the safest care for patients, and the safest thing is to leave the general anesthetics to those trained in administering general anesthesia.

You may disagree with JWK, but more than 20 professional nursing organizations, the AMA, ASA, AANA, and JCAHO disagree with YOU. Current clinical practice guidelines for the provision of procedural sedation state that non-anesthesia providers should not be administering any drug labeled as a general anesthetic, including propofol, ketamine, brevital, etomidate, or STP, for procedural sedation. Joint Commission, though they don't specifically address particular drugs, says that if YOU are pushing any particular drug for procedural sedation than YOU better be able to rescue the patient from any level of sedation, including deep sedation or general anesthesia, that may develop. YOU. Your statement regarding reserving propofol for head bleeds and traumas indicates that you do not possess the knowledge necessary for administering these agents.

I'm not trying to flame you in any way, pinktermite, but I have done considerable reading on this subject as it is the crux of my master's thesis. This topic always brings out the heat from folks, and it's difficult for me to understand why. It's not about questioning anyone's clinical skills really, it's about providing the safest care for patients, and the safest thing is to leave the general anesthetics to those trained in administering general anesthesia.

Well said, I think that you said everything that I wanted to say :).

It is so scary that so many nurses are quick to use these sedation medications when it is obvious from their posts that they have no clue of their uses or the ramifications of over sedation. This is not directed at anyone in particular, but sometimes I think it is swelled ego syndrome and the fact that they don't know what they don't know. Wait till the first time they put a patient into respiratory arrest and a doctor has to save their back sides.

Propofol is a safe drug as long as it is given carefully and slowly and someone is present who can quickly perform airway management if necessary. Like ALL drugs, the person using it needs to be familiar with all of its effects.

Propofol is extremely short acting and the negative effects of propofol usually wear off much more quickly than those of versed, which, in my opinion, is no more predictable than propofol. The same precautions should be taken during any CS, no matter the specific medication used.

We use it routinely for conscious sedation in the ED and in flight. Granted, when we use it in flight we are usually using it for induction for intubation, but not necessarily.

Propofol is a safe drug as long as it is given carefully and slowly and someone is present who can quickly perform airway management if necessary. Like ALL drugs, the person using it needs to be familiar with all of its effects.

Propofol is extremely short acting and the negative effects of propofol usually wear off much more quickly than those of versed, which, in my opinion, is no more predictable than propofol. The same precautions should be taken during any CS, no matter the specific medication used.

We use it routinely for conscious sedation in the ED and in flight. Granted, when we use it in flight we are usually using it for induction for intubation, but not necessarily.

I'm tellin' ya boys and girls - read that package insert, then decide how you'll EVER defend yourself if something bad happens. All your hospital-lifeflight-nursing-ED-GI-I've been inserviced-protocols won't mean SQUAT to a jury.

It's rarely used for "conscious" sedation in the ED. And inducing general anesthesia in-flight ain't my idea of a great thing to do either.

I'm tellin' ya boys and girls - read that package insert, then decide how you'll EVER defend yourself if something bad happens. All your hospital-lifeflight-nursing-ED-GI-I've been inserviced-protocols won't mean SQUAT to a jury.

I don't know what to tell you...the ED docs I work with are comfortable with it, the hospital administration is comfortable with it, the clinical pharmacists are comfortable with it, myself and the other nurses are comfortable with it, and frankly, I have never even heard of any problems with it. Personally, I am more comfortable with propofol than I am with large doses of versed.

I can also find nothing in the package insert or my states' nursing practice act that indicates that we should not be using it or that we are using it innapropriately.

You can dislike the idea of "general anesthesia" in flight all you want...I can tell you it's a very common practice. I've personally been doing it for several years now and have never had a single problem.

I don't know what to tell you...the ED docs I work with are comfortable with it, the hospital administration is comfortable with it, the clinical pharmacists are comfortable with it, myself and the other nurses are comfortable with it, and frankly, I have never even heard of any problems with it. Personally, I am more comfortable with propofol than I am with large doses of versed.

I can also find nothing in the package insert or my states' nursing practice act that indicates that we should not be using it or that we are using it innapropriately.

You can dislike the idea of "general anesthesia" in flight all you want...I can tell you it's a very common practice. I've personally been doing it for several years now and have never had a single problem.

You should read that package insert again - you're missing the part about it being used ONLY be those trained in administering general anesthesia which you are NOT. And again, it doesn't really matter what you or your hospital thinks is appropriate.

And I'm glad you NEVER have a problem. Trust me, some day you'll get humbled. There is a huge difference between competent and cocky, which obviously you and many others have not figured out yet.

You should read that package insert again - you're missing the part about it being used ONLY be those trained in administering general anesthesia which you are NOT. And again, it doesn't really matter what you or your hospital thinks is appropriate.

And I'm glad you NEVER have a problem. Trust me, some day you'll get humbled. There is a huge difference between competent and cocky, which obviously you and many others have not figured out yet.

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.