Your PROPOFOL stories wanted

[RNNCcicu98]

I am preparing a presentation on using propofol as a continuous infusion for sedation on vented patients. Although I have my own personal experience administering/maintaining this drug, I was hoping for some feedback and/or stories about YOUR experiences with propofol. My goal for this presentation is to educate and prevent unexpected adverse events.

Our CICU uses propofol occasionally (midazolam is the drug of choice...), and of course we use an analgesic as well. I have researched this drug extensively, and am aware of the common side effects. BUT, we all know that experience brings information that at times is not found in research alone.

What tips/cautions/lessons have you learned about propofol? Share away! Thanks so much for your contribution.

[eCCU]

I am preparing a presentation on using propofol as a continuous infusion for sedation on vented patients. Although I have my own personal experience administering/maintaining this drug, I was hoping for some feedback and/or stories about YOUR experiences with propofol. My goal for this presentation is to educate and prevent unexpected adverse events.

Our CICU uses propofol occasionally (midazolam is the drug of choice...), and of course we use an analgesic as well. I have researched this drug extensively, and am aware of the common side effects. BUT, we all know that experience brings information that at times is not found in research alone.

What tips/cautions/lessons have you learned about propofol? Share away! Thanks so much for your contribution.

AACN had a good article on "propofol infusion syndrome" published june 2008. I remember it because it was very interesting case study included and I presented it to my staff back then....worth taking a look :-)

http://m.ccn.aacnjournals.org/content/28/3/18.full

[ktliz]

Propofol is our go-to drug, usually with 50-100 of fentanyl Q1H PRN, or sometimes a fentanyl gtt. If propofol (max of 80) doesn't keep the patient adequately sedated, then we will go to midazolam. We don't check trigylcerides routinely, only if the patient has been on the drip for a while (around a week). Have seen symptomatic bradycardia once that I can remember.

I feel like a patient is either the type that will tolerate being intubated, or the type that won't. Some people will never achieve that RASS of 0 or -1, no matter what drug or what dose you give them. They're either agitated or snowed.

Only other thing I have to add is that although RNs are forbidden from pushing propofol, I know some people will jack the rate way up on the infusion in a pinch, then turn it back down once the patient settles....

[Chaswald]

We use propofol quite a bit in the CVICU i work in. Though i have found that the off service intensivists tend to use midazolam/fentanyl combos more often. I have had that experience with extubating a morbidly obese patient from propofol. He was incredibly confused and pulled at lines for much longer than a normal extubation would. Turned out he had rhabdo, so after treatment for that and he was fine. I have only had that experience once though.