Sedation..Your thoughts?

CCL RN, RN · Mar 29, 2011

In my state I cannot bolus propofol-->at all! I would most definitely lose my license...

Da_Milk_of_Amnesia, MSN · Mar 31, 2011

there has been plenty of nurses that have been far to cavalier with pushing this drug that has resulted in disasterous results. i think the op stated that they gave a mini bolus of this drug for a conscious sedation, which is a no no at my hospital.

No there were no further boluses of Dip given obviously because of her hypotension. We are allowed to push dip as long as we have a MD who is able to intubate there and ready just incase. We use it during our RSIs and conscious sedations.

However, there are nurses I work with who do occasionally given boluses of dip to an already intubated patient, when they get a little rowdy. Obviously you wouldn't do that to someone who was spont. breathing.

RN1980 · Apr 2, 2011

No there were no further boluses of Dip given obviously because of her hypotension. We are allowed to push dip as long as we have a MD who is able to intubate there and ready just incase. We use it during our RSIs and conscious sedations.
However, there are nurses I work with who do occasionally given boluses of dip to an already intubated patient, when they get a little rowdy. Obviously you wouldn't do that to someone who was spont. breathing.

man, im sorry i posted on the wrong thread referring to another different title concerning diprivan boluses and gtts. sorry for the mix up.

sunnycalifRN · Apr 3, 2011

If a ventilated patient is lightly sedated, opens eyes to voice, follows commands, etc . . as long as the patient is comfortable, not in pain, not hypertensive or tachycardic . . . that level of sedation is fine.

Haha, a few nights ago, had the opposite . . . a patient on 500 mcgs fentanyl, 8 mg versed and 1.2 mcg dexmedetomidine and was wide awake . . . wild-eyed . . . thrashing about, going for the tube . . . had to go up to 800 mcg fentanyl, 10 mg versed and added propofol before he finally quieted down . . . but he could still be awakened!!! Yes, IV drug user!

steelydanfan · Apr 7, 2011

So I just have a question for my fellow icu RNs. I had a patient last night who while even sedated on 50mcgs/kg/min of propofol and 6 of versed was able to open eyes and follows commands and respond appropriately. I asked her several times if she was comfortable to which we nodded 'yes'. Her Peak pressures were all fine in, her HR was 90s-100s, which is better than the 110-120s she was when she got to me and her BP was now 100-110s which was better than the 70-80 when she got to me (septic, severe PNA). I made the decision to not call the MD and not add anymore sedation to her. She was triggering the vent at a rate of 20-22 on PRVC. So my question is, what would have you done? I know some people like to have their patients snowed wayyy down, but I don't like to. She was a young girl in her 30s, and since she was hemodynamically stable (on only 2.5mcg/min of levo, down from the 10mcg/min she was initially on) I decided to keep her where she was. I know it's a judgement call and everyone will have their own opinion on what they would have done, but i am curious to know. Thanks.

The pt. was comfortable, and if she was able to sleep. she was fine. I really would not try dialing the sedation down on the night shift, let the oncoming nurse know your findings, and they can confer with the attending as to the pt.s readiness for decreased sedation or vent changes.

Darkfield · Apr 7, 2011

Propofol and Versed are meant to accomplish the same task. There is no pain medicine on board there. What kind of sedation protocol were you following? We usually do Fentanyl and Versed, if that doesn't cut it, then Fentanyl and Propofol.
50 mcg/kg/min of Propofol is a ton to me. I've seen hardcore heroin withdrawal patients get snowed off of 15 mcg/kg/min. Perhaps with a pain med on board you could have even turned the rate down further. Granted she was exactly where you wanted her to be, that's a heavy amount of sedatives.

That is not a ton of propofol. Are you sure you're not talking about mg instead of mcg? Most people I've met can stay awake on 15 mcg/kg/min.

In answer to the original question, if the pt was comfortable, I'd leave her where she was. That's actually ideal, someone that will wake up a little bit, but is not uncomfortable. Sometimes you have to snow pts if they are unstable or fight the vent or are on a vent setting that requires near paralysis for compliance. But hold off if the pt tolerates it, I think. You ever meet the folks that have been snowed for two weeks or more? It takes them a long time to come back to planet Earth.

mpccrn, BSN, RN · Apr 13, 2011

I would have left her there. She was comfortable and oxygenating.

Da_Milk_of_Amnesia, MSN · Apr 15, 2011

That is not a ton of propofol. Are you sure you're not talking about mg instead of mcg? Most people I've met can stay awake on 15 mcg/kg/min..

Actually for our protocols 50mcg/kg/min is our max rate for dip. We usually start to add either Morphine or Ativan if the propofol cannot hold them in a happy place. We use the rass scale, most patients we keep around a -3. I believe if you have a person at at greater than 4MG/kg/hr you run the risk of putting someone into it. Im not about to do the calculation now but our docs say no more than 50MCGs/kg/min

sunnycalifRN · Apr 15, 2011

I'm confused: why on earth would you be bolusing someone with propofol unless they were intubated or for the purposes of RSI?

Our anesthesiologists will bolus a non-intubated patient with 10 to 20 mgs of propofol during moderate sedation procedures. We, RN's, are not allowed to push propofol at my workplace.

**LaurelRN, MSN · Apr 16, 2011

I would have left her right where she was. I had a guy yesterday- 80mcg Propofol, 12mg Ativan, 200mcg Fent, and still opening his eyes and squeezing my hands. He was a drinker so what you describe is not alot in my experience

CCL RN, RN · Apr 16, 2011

50mcg of propofol ain't squat!

Especially for drinkers, or self medicators. You know, like the majority of our patients!!

sunnycalifRN · Apr 16, 2011

50mcg of propofol ain't squat!
Especially for drinkers, or self medicators. You know, like the majority of our patients!!

You're so right. I have to run the propofol at 100 mcg routinely and the pharmacists are always ranting and raving!! We used to have the propofol as ward stock but now pharmacy keeps it locked up in some secret hiding place!!