Re: Propofol

["david lichtman" <davidlichtman@medscape.com>]

This is an excellent drug, and works incredibly well in the extra-
hospital environment.
1)The fact that this drug is not even listed as a scheduled class 
medication, makes the paperwork issues for certain systems a huge 
plus.
2)The drug is able to be titrated so that administration is perfectly 
tailored to the individual patient responses.
3)The drug has an incredibly quick onset (9-30 sec) and a very clean 
recovery.
4)It is cerebral-protective which is critical for those patients with 
head trauma.
5)It can be used for induction, maintenance, and procedural sedation.

The list continues, just read the drug information provided.  As far 
as the increased stimulation of the helicopter impeading the effects 
of the drug, this drug was designed to be used during surgical 
procedures.  I don't think one can stimulate a patient to a greater 
degree than with surgery.  If the current level of propofol is not 
holding the patient to a satisfactory degree of sedation, increase 
the rate.  As far as the addition of a neuromuscular blocking agent 
is concerned, virtually all of the known agents can be utilized along 
with the propofol.  Remember, like versed, etomidate, and pentothal, 
propofol is used for sedation, and is not a paralytic.

Nonetheless, no matter how much I like this particular medication, 
the one point I think we should all remember is that there are lots 
of different drugs available, and that every patient will respond to 
each of them in his/her own unique manner.  None of us would ever 
transport a patient with only a single size ET tube, so why restrict 
ourselves when it comes to medications.  Carry as many different 
medications as you can, and tailor the drug regimen to the patient, 
not the other way around.

Sorry I rambled on,
David Lichtman

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