Using Propofol for sedation on vented pts?

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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.

The patient was going to get a vena cava filter so I drew up 100mcg of diprivan, pushed 50mcg (5ml) and off he went to the OR.

Why are you giving propofol IV push?

Upon his return I was faced with the same dilema. How do I keep this guy from desaturating to 88% because of his restlessness.

provided sedation and pain control, 10mg of vec will end the restlessness.

I see that all but 1 post chose Versed as benzo over Ativan do you find that it works better and why. We use alot of versed as well. Some times I follow whats being done when I come in. Perhaps had I switched over to versed I would have not needed to place on diprivan. Pt. has hx. chronic alcohol use thanks for reminder to monitor triglycerides/amalase/lipase .

Ativan can make folks go super nuts sometimes. Versed has amnesia properties.

You mention the pt has hx of etoh abuse.....that's why he was restless and was not sedated with 2 of ativan and 250 of fentanyl. The substance abusers burn through sedation like there is no tomorrow.

Also don't forget to monitor lactate levels for lactic acidosis.

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Meandragonbrett,

The iv (bolus) was the only way I could figure to calm him down. It's rarely given this way except for road trips to CT.

Did you mean Vecuronium? Paralysis would have worked too. I hadn't thought of that. He had been kept paralized for days. At one point it occured to me that the Ativan was making him worse.

Our docters are notorius for rounding in the morning and saying turn all the sedation off. What guidelines do you follow, if any regarding "weaning to off"?

I read somewhere that narcotics be halfed each day untill 0. Sometimes we will start on methadone.

Sorry for straying from the wonderous diprivan...

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Do you ever bolus Propofol from your IV pump? If so, how much? Do you have a standing order for it or is it just something you do based on nursing judgement?

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Specializes in Cardiac.
Do you ever bolus Propofol from your IV pump? If so, how much? Do you have a standing order for it or is it just something you do based on nursing judgement?

Umm, if I want to risk losing my license. RNs (at least in my state) cannot bolus propofol-ever.

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When orders for diprivan are written they may state titrate to sedation ramsey 2-3 so for example. If the bottle runs dry as occasionally it runs dry even to the best of us. a pt may need a bolus to get them calmed down, they are left at the maintenance dose of say 20ml/hr. Also they grow acostomed to a set rate and need to be adjusted sometimes first giving a bolus of say 3-5mL. Some pts are very sensitive to the diprivan and 5ml would sink there BP it's all at the nurses discretion.

That's how it was shown to me when I came to the SICU.

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Specializes in Cardiac.

You might want to check with your BON about that...

What people do and what's within our scope are two different things...

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Specializes in MICU/SICU.

Propofol is milky white goodness. We aren't allowed to bolus it. Strict policies outline it's titration using a written starting rate, ie., 10 mcg/kg/min, and titrate to a rass of -2. We get the MD's to bolus (vented patients only) when needed, though they occasionally telepathically bolus while inserting a line. It's hard to multitask when you are in a sterile field.

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Specializes in Geriatrics, Cardiac, ICU.
Propofol is milky white goodness. We aren't allowed to bolus it. Strict policies outline it's titration using a written starting rate, ie., 10 mcg/kg/min, and titrate to a rass of -2. We get the MD's to bolus (vented patients only) when needed, though they occasionally telepathically bolus while inserting a line. It's hard to multitask when you are in a sterile field.

So nurses cannot bolus propofol?

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Specializes in GSICU, med/surg.
What do you mean by diprivan having "less effects than versed for sedation?" Are you talking about the half life? Propofol is a general anesthetic and versed is a benzodiazepine. Propofol is going to cause MUCH more sedation than versed does.

sorry i meant this: versed has more effects on blood pressure than propofol does (this is what the docs tell me anyways). but yes, propofol is much better for sedation all round. sorry i wrote that when i was tired and wasnt clear!

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Specializes in GSICU, med/surg.
So nurses cannot bolus propofol?

we are allowed to bolus propofol, but usually only during procedures or if a patient is really wild.

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Specializes in MICU/SICU.

so nurses cannot bolus propofol?[/quote]

correct. by our hospital policy, crna's or mds only.

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Specializes in Cardiac.
sorry i meant this: versed has more effects on blood pressure than propofol does (this is what the docs tell me anyways). but yes, propofol is much better for sedation all round. sorry i wrote that when i was tired and wasnt clear!

Versed has more effects on BP than propofol???? I don't think so.

we are allowed to bolus propofol, but usually only during procedures or if a patient is really wild.

Not in my state! I will be explaining my actions in front of the BON if I'm caught doing so, in addition to losing my job.

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