Question???? Please reply

[Bubblegum12]

hi can someone please tell me which drip you titrate down first and why versed or diprivan? Thanks.

[ausrnurse]

Midazolam hangs around for a long time, we usually turn that off as soon as there is talk of extubation. Propofol can be turned off like 10 minutes before you want to extubate, so we will leave that on and titrate up or down as required.

[LNRN11]

^^^ Exactly what they said. It can take people quite awhile before they wake up from Versed, especially if they already have renal or hepatic issues. Diprivan is very quick! I've had patients where you shut it off and it seems like they are awake almost instantaneously. Careful when you are titrating up; it can tank your pressure.

[Bubblegum12]

Thanks so much for the reply, my patient was agitated but pressure was in the low one hundred, I know diprivan lowers pressure so was going up on versed and down on propofol, new to icu and was pulled to er ughhhh...asked doc for pain control for pt..what do u think. :)

[Esme12, ASN, BSN, RN]

What is the patients situation?

[Bubblegum12]

Admitted for respiratory failure, pneumonia, vented on prvc,

[Bubblegum12]

Thanks for the reply :)

[ausrnurse]

Thanks so much for the reply, my patient was agitated but pressure was in the low one hundred, I know diprivan lowers pressure so was going up on versed and down on propofol, new to icu and was pulled to er ughhhh...asked doc for pain control for pt..what do u think. :)

Hm, may be a different situation. Our ER totally flattens their ventilated patients with midaz/morphine, which we change straight away when they get to ICU. If they were still in the emergency department, it's better to just do what you have to do to keep them safe until they get up to the ICU imo.

Ventilated patients should have sedation and pain relief, so you were right in asking for pain relief.

[MunoRN, RN]

Practice guidelines typically recommend analgesia first, sedation/anxiolysis second, you don't want to just sedate someone who might be having pain. Post-vent delirium is more strongly linked to benzos than opiates; another reason analgesia should be used preferentially. So, to answer you question, I'd titrate off the versed first and ask for some form of analgesia with propofol as needed beyond adequate analgesia.

[Bubblegum12]

Thanks so much for the reply :)

[ghillbert, MSN, NP]

Depends on the reason too - if someone was significantly hypotensive, I'd drop the propofol due to its shorter half life and more immediate improvement to hemodynamics. Sedation wise, certainly drop versed first as it will take longer to be eliminated as stated by others.