Re: PROPOFOL

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

Thanks for the information, I always appreciate learning new things.  
I had always thought that Diprivan was not contraindicated in 
patients, but was contraindicated in hypotensive patients.  I realize 
that patients who are hypovolemic are prone to hypotension; however, 
I thought that the meds administration was deemed appropriate so long 
as the blood pressure was within normal limits, being that the 
duration of action of the Diprivan was so short.  In this train of 
thought, the drug would be gone before any drop in blood pressure 
secondary to the effects of the decreasing circulating blood volume 
would be realized.

Another point I attempted to make was that Diprivan should not be the 
only choice when a service is considering using sedative; however, it 
should be incorporated into a compendium of medications and protocols 
that allow for dynamic responses to individual patient statuses.  
Furthermore, I do not know how the helicopters operate in your area, 
but severe hypovolemic, hemorrhagic trauma is only one part of aour 
patient population.  Many are medical patients with significant 
issues at hand.  Others are traumatic injuries, with a significant 
number being head injuries.  These head trauma patients are at risk 
for a number of post-traumatic complications, but hypovolemia 
secondary to severe hemorrhage is not necessarily the main issue.

I would appreciate any further information, comments, and literature 
siting you have to offer.  I really do want to understand this to the 
greatest degree possible.

Have fun and be safe,
David Lichtman

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