Propofol, my friend and yours
Oct 26th, 2007 by Terry
If there is one drug which truly enhances the arsenal of an anesthesia provider, that drug would be Propofol.
What is Propofol? Chemically described as diisopropylphenol, it is an emulsion; it is white, it contains soybean oil. It is a sedative-hypnotic agent that is used for the induction and maintenance of both general and sedation anesthesia.
Propofol is my friend. And Yours.
It has a very quick onset and short duration. When You need a colonoscopy, I can deliver squirts of this milk of amnesia in just the right amounts to keep you sleepy enough to not feel or remember a thing. You will wake up almost immediately after the procedure and just look at me incredulously when I tell you that it’s over and done.
It is also quite useful for cases where your surgeon can work on You using local anesthetic. As anyone knows who has been to the dentist, sometimes the administration of local anesthesia can burn and hurt. A couple of squirts of Propofol by me will help you nap through the numbing process, and never even feel the needle, let alone the actual surgery.
Let’s say You are having a minor procedure but you are just plain scared or uncomfortable about being in the operating room setting (I’m thinking podiatry, minor hemorrhoids, cataracts, breast biopsy for a small lump, and the like). *[ Note - most folks having these procedures get some type of sedation. There are an occasional few people who prefer NOT to be sedated at all, and that’s perfectly alright, too.] Propofol to the rescue after you’ve been numbed up, to give you that cat nap that you crave and need. It can easily be delivered as a “drip” and titrated to the desired effect. Combined with other IV drugs like benzodiazepines (think Versed - sedative) and narcotics (think Fentanyl - pain-killer), it creates an ideal sleep, where You can maintain your own airway and breathing, and I can watch over you and monitor your depth and adequacy of “LaLa-Land.”
For patients getting spinal or epidural anesthetics for their surgery (lower extremities and sometimes lower abdomen), a Propofol infusion will allow You to zone out for the duration of the operation. When a general anesthetic is required, where I will need to secure your airway with some type of breathing device, I administer Propofol in much much larger doses, as this will produce not only unconsciousness but also apnea (stop breathing) and a blunting of your gag reflex. Maybe more information there than you cared to know (sorry), but it definitely makes my job much easier, which ultimately makes taking care of You a much safer experience. After this “mega” dose of Propofol wears off (remember, I said it was short-acting), I can keep you asleep with either more Propofol, or other intravenous or inhalation agents, and assist your breathing as required.
I also use Propofol in “remote” settings throughout the hospital (any place away from the OR) - for cardioversions, where You need to be a little dazed for the jolt you will receive; same holds true for ECT - electroconvulsive therapy; and it is a lifesaver on any patient unit when someone needs to have a breathing tube placed - smaller or larger doses, it provides a short and quick solution to sedating a distressed patient.
So, say hello to my little friend…
Hello little friend……
The word emulsion brought up images offset printing terms. I started thinking “is it coated in the veins after you inject it?”
I really like this drug. It works wonders in the ICU environment as well, and when I had it administered once for oral surgery it was amazing: I made the count backwards to about 96 before I was drifting away, and then as soon as I was asleep the operation was over. Truly this is the Milk of Human Kindness.
[…] have to be the wonderful, beautiful and heavily-used drug Propofol. Terry at Counting Sheep has a wonderful post about this drug, which I urge you to go read […]
A question about weaning– have you seen people have bad reactions if you turn off a propofol gtt. as opposed to gradually decreasing? I work in a neurosurg ICU and i have to lighten sedation for the docs (and me) to do neuro exams, and it seems when you just turn it off, people get really agitated and/or hypertensive, ICPs go up, etc. Some nurses just turn it off.
I also love propofol; in our setting, where we often have to control blood pressure to prevent brain vasospasm, propofol is easier to use to keep BP in a narrow range.
I *heart* propofol, always have. I see a significant difference in the comfort and healing of my ICU vent patients when we keep them happy with the mothers milk. . .
Totsu, I would imagine that if you needed to lighten up a patient, it would not be necessary to totally turn off your drip; rather, just turn down the rate significantly. The problem is, no one knows just how light you should make your infusion, as each patient has individual needs. Coming out of a Propofol “coma” or even waking up from anesthesia in the OR can be a disorienting experience, and the first thing I always do is ORIENT, ORIENT, RE-ORIENT the patient. We call it emergence delirium, and it would be the same thing for someone on a continuous drip in the ICU. A little talk therapy may do wonders for your patients as they are being awakened (although I imagine you probably already do that). Do you have access to BIS monitors, as they are wonderful gauges to determine the level of awakeness of your patient, and may help you titrate for an awake test more effectively.
Very informative.
I thought this was an interesting post. I recently had some podiatric surgery and I am sure this is one of the drugs that was used. I walked into the operating room, climbed on the table, stretched out my arms and don’t remember anything else. I remember them asking me to take a deep breath and I remember talking a lot upon awakening. I never felt sick to my stomach as I have had with general anesthesia and I didn’t even feel very foggy or anything.
If this is the drug that I had, then I certainly understand why you are so appreciative of it. I had a good experience.
I am afraid I must differ with the above opinions about propofol in most instances. This is an over-used and dangerous drug to use in ICU’s - it has such profound cardiac depressant properties that it is contraindicated in all but young, healthy patients. By definition if you are healthy you are not in an ICU.
It can cause seizures after stopping even short infusions, it can cause bad pancreatitis, it interferes with glucose metabolism, and it has no analgesic effects. Patients wake up “hard” after it is stopped usually because they are in pain which has been masked by the anesthesic properties.
It causes patients to be motionless and contributes to deconditioning and DVT’s.
ICU nurses like it because the patients do not move or buck the vent or complain and it makes for an easier shift, but that is not necessarily better for the patient.
Many top academic ICU’s NEVER use it - including at UPMC, Hopkins and others.
Propofol is a hypnotic, not an amnestic (amnestics are versed and valium and the like). There are cases of total iv anesthesia with intraoperative recall, some very famous, in which propofol is the main agent. I do agree, propofol is wonderful and patients state feeling great after the procedure. It’s anti-nausea effect is a huge plus.
Yes, Propofol is a hypnotic/sedative, but it does have amnestic qualities, and that is very well documented. While many ICUs use it for sedating their ventilated patients, it must be delivered and monitored by someone who is quite familiar with its pharmacokinetics and pharmacodynamics, so that the patient is being given a proper and complete sedation. I cannot attest to how often this is the case.
What I can address, and I would like to reassure my readers, is that Propofol, in the hands of a competent and properly-trained anesthesia provider, will provide a moderate amnesia. Please read here:
http://everydaynurses.com/wordpress/2007/11/26/the-power-of-our-drugs-an-anectdotal-story/
Peopofol can be a great drug; for me (trained as a clinician), it was a nighmare…I had a “simple” 100% FTD and ulnar release surgeron on my right side and was scheduled for the sameon my left….I told the CRNA that the only way that I would agree to receive propofol was PCA or on demand in 10mg increments and they went nuts…..for the original procedure that lasted 1.5 hrs. some sedtion might have been fine; but to just push propofol by a CRNA to keep me imobile and “amnesic” (sorry it didn’t worl that way) was a joke….as a clinicial, I usually support CRNA/s…..sorry, not anymore…. since I have tohave the other arm done, I asked for PCA ( a pump or a CRNA who would do it) with propofol bolus of 10-20 mg on demand and was treated like “an idiot”…fine..I’ll skip the possibly nerve-sparing surgery…nurses (RN
Gareth, sorry to hear about your negative OR and anesthesia experience. I’m not really sure I completely understand what you are trying to say - you wanted to administer your own Propofol during an operative procedure?
Yeah; it’s called PCA (patient-controlled anesthesia…) not reqally a new thing; it’s done in MANY institutions
For you enlightenment and education, GarethB, PCA stands for patient-controlled analgesia, not anesthesia. There is no patient-controlled anesthesia - not now or ever.