Comments on: Propofol, my friend and yours

By: Janette Bach

Janette Bach — Sat, 27 Oct 2007 08:06:20 +0000

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?”

By: the anonymous therapist

the anonymous therapist — Sat, 27 Oct 2007 17:05:24 +0000

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.

By: I like ‘em sedated « Respiratory Therapy 101: Just Keep Breathing

I like ‘em sedated « Respiratory Therapy 101: Just Keep Breathing — Sat, 27 Oct 2007 17:20:32 +0000

[…] 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 […]

By: Totsu

Totsu — Sun, 28 Oct 2007 00:29:16 +0000

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.

By: mielikki

mielikki — Sun, 28 Oct 2007 06:23:34 +0000

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. . .

By: Terry

Terry — Sun, 28 Oct 2007 10:55:02 +0000

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.

By: Rick Frea

Rick Frea — Mon, 29 Oct 2007 00:46:13 +0000

Very informative.

By: Elissa

Elissa — Wed, 31 Oct 2007 23:39:00 +0000

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.

By: LymeHealth.com

LymeHealth.com — Tue, 06 Nov 2007 03:04:29 +0000

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.

By: name

name — Thu, 29 Nov 2007 19:44:22 +0000

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.

By: Terry

Terry — Sat, 01 Dec 2007 16:36:36 +0000

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/

By: gareth B

gareth B — Mon, 07 Jan 2008 12:51:59 +0000

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

By: Terry

Terry — Mon, 07 Jan 2008 23:21:43 +0000

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?

By: gareth B

gareth B — Sun, 20 Jan 2008 04:40:27 +0000

Yeah; it’s called PCA (patient-controlled anesthesia…) not reqally a new thing; it’s done in MANY institutions

By: Terry

Terry — Sun, 20 Jan 2008 10:48:40 +0000

For you enlightenment and education, GarethB, PCA stands for patient-controlled analgesia, not anesthesia. There is no patient-controlled anesthesia - not now or ever.