Re: propofol (was: Etomidate)

[mvojtko@juno.com]

I'd agree with Carol, although I've never used Propofol pre-hospital.  When you push it,

you can really get yourself in a jam, although the hemodynamic recovery is pretty quick.

Although I haven't researched every aspect of the drug's mechanism of action, you would

think that something that works so quick knocks down the sympathetic nervous system,

and subsequently causing the vasodilation and the negative inotropic effect.  Might not

be in the best interest of the patient with a really bad boo-boo inside his skull.

 

I've used gallons of the stuff in the ICU, and it really is a great agent, however it is grossly

overused.  You really shouldn't be using it for more than 72 hours.  If your patient is on

TPN and propofol concurrently, there should be an adjustment in the amount of

lipids put into the TPN.  Also, after you have it up for more than 24 hours, you should be

checking the patient's triglyceride levels (can't remember how many times I've seen

AMI patients in the CCU on Propofol, and getting a scheduled 'statin).  When it's used

on patient's with DT's, they take a holiday from their withdrawal while they're out, and

then pick up where they left off when you wake them up.

 

Some other problems with Propofol is you should be using a dedicated line with

administration, as you will be unable to detect any sort of precipitate (yes, anesthesia

types do it all the time, but it's their butt when something goes wrong).  Even though there

are published compatibility charts, Murphy lives in the RSI kit too! 

 

Propofol is a wonderful medium for infection, regardless of how good your aseptic technique is.

It can also be cost-prohibitive for regular use.

 

I've had great success with Etomidate at 0.3 mg/kg  (adults and peds) followed by a Versed

chaser after about 3-5  minutes. 

 

Good discussion!

 

MV

 

On Tue, 4 Mar 2003 16:25:36 EST Carol57r@aol.com writes:

My experience with Diprivan in the prehospital setting has not been positive. It is a negative inotrope and a venodilator. Used as an induction agent in the field it invariably causes hypotension. Its use in the ICU/OR where hemodynamic status is better regulated has proven effective and excellent for use with head injuries. However, I frequently see it used in continuous drip form on patients with compromised cardiac status i.e. cardiogenic shock. It is also very expensive.