Using Propofol for sedation on vented pts?

[Scrubz]

Is Propofol used on vented patients? Since the half-life of Propofol is so short wouldn't it be more justified using a longer activing sedative? I assume that Propofol isn't used for long-term vented pts right? Maybe just initially?

I'm still in school so I have no experience with any of this other than what I hear or see, so thanks for any responses. I was just curious.

[suanna]

We use Propofol frequently for our post-op patients that wake up a little wild on the vent. The best property is that unlike narcotic or benzo. sedation you can frequently wean the vent to near extubation settings without cutting off all sedation. One problen for longer use (at least in my experience) is tolerance developes quickly requiring increasing doses as the days go by.Also beware the "diprovan drools"- vastly increased oral secreations with a diminished cough This is just asking for a pneumonia- frequent mouth care & suctioning [good nursing care] helps solve this problem.

[dfk, RN, CRNA]

propofol has an initial T1/2 of about 40 minutes, but also has a terminal T1/2 of anywhere from 4 hours to roughly 3 days.. it hangs out in adipose tissue, so prolonged sedation can actually occur. also, a previous post commented on using lidocaine in the bottle.. it is not labeled as such a use, but can be done... not that i'm promoting it ! ... also, propofol has mild anti-emetic properties.. now, that is one nice drug

[pebbles, BSN, RN]

We use propofol in our ICU.

Almost always it is in combination with other drugs - analgesic and also a longer-acting sedative. We commonly run fentanyl and midazolam infusions as well. That way, we don't have to (usually) use such large doses of any one drug.

Propofol is great because it is so short acting. You turn it off, wait a few mins, do a thorough assessment of the neuro status, and then turn it back on.

A known side effect is apparently erotic dreams..... (one of my ICU course instructors confirmed this!!)

[meandragonbrett]

Our PharmD gives the reasoning for this as the risk for increased triglycerides and Propofol Infusion Syndrome, though quite frankly, at the last ICU I worked at we used Propofol for longer than 48 hours and I never heard of anyone developing that syndrome...

While the increased triglycerides and propofol infusion snydrome are real concerns, it is not as common as many think.

Also, there was no reason not to be giving the PRN narcotics to this patient.

[Bonnie Nurse]

Downside of using propofol long-term is an increase in chance of patient's developing pancreatitis, I believe, due to the lipids in the drug.

[criticalHP, MSN, RN]

We use propofol for our vented patients, although I have to say I don't always see additional infusions of analgesics concurrently ( less than 50%)unless the patient was trauma, surgical, or hx of chronic pain. Usually a PRN order for morph. or fent. is given, but non-verbal pain measurements are subjective, and I feel patients in my unit are being under treated for pain. I've brought this up at our UBC and to the intensivists but so far no changes. I try to impart this point on newbies that I precept anyway to break the chain of bad habit.

As far as names.I've heard...propofol=diprivan=milk of amnesia=mothers' milk

[Guest193822]

For long term we use Versed & Fentanyl even though it takes time for weaning off, but we do have morning wake up everyday which can be an issue at times U know what I mean

We also use propofol but when we are sure we are extubating soon, or if we have a neuro pt that need frequent neuro checks. It's a quick wake up & put then down.

Propofol DOESN'T DO ANYTHING FOR PAIN. I had to explain that to a newbie this week.

[RNforLongTime]

I've been told several different reasons why my facility doesn't like propofol. Because it can cause hypotension (duh?) and can cause the triglyceride level in the pt to skyrocket--again duh? Me thinks it has more to do with because it is so expensive.

I said well if a pt is hypotensive, then we turn down the drip. And there should be a policy to be sure that the pt's tryglyceride level is checked every few days while on diprivan.

[meandragonbrett]

A lot of the hypotension can be caused by bolusing the propofol too.

[aDDctd2sBUX]

I hope this isn't redundant, but Propofol is often used during general anesthesia along with various opiates (afent, sufent, etc.) and a neuromuscular blocker, if the pt has a family history of malignant hyperthermia.

[Nurse Lulu]

We use diprivan with morphine and versed as part of a vent "bundle". We always titrate it based on weight (our intensivists demand it) as it can become toxic due to fats (PIS). Blue-green urine. Saw it in person once. More common than you think. Also tubing changes very important.

[Hoozdo, ADN]

Interesting discussion. We use Diprivan commonly in my ICU for vented patients - it is the drug of choice. A very bad trend in my ICU is NOT having a narcotic analgesic prescribed along with the Diprivan. :trout:

I complained to my manager about this after my first 30 days of employment. She asked, "what can we do to change this?" I said, "give the docs some evidence based protocol that Diprivan is NOT intended to relieve pain."

Problem - this is just such a basic fact, I can't find any evidence based practice papers written on it! The best thing I can find is the prescribing information in the Diprivan box - it is not intended for pain relief! Does anyone has links to any EBP articles?

Another issue - my hospital wants to limit the upper dosage to 50 mcg/kg/min. If a pt has any narcotic tolerances, this dosage limitation doesn't cut the mustard at all. I have had many pts bucking the vent at even 150 mcg/kg/min. Any input on dosage restrictions?