Propofol for procedural sedation
I have some experience with proposal but I wanted to get a sense of what the other guys here use.
I usually just do slightly less than 1mg/kg initial bolus and then re-bolus as needed at a little less than 0.5mg/kg. So in an 80kg pt, I usually just do 60 + 30 + 30 as needed. I've only done this twice.
What about you guys?
I've heard that some just do like 40 + 20 + 20 + 20 until adequately sedated on a 80kg patient. While others just give a slug of 80 then re-bolus at 40 at a time...
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Source: Student Doctor Network - March 30, 2024 Category: Universities & Medical Training Authors: pinipig523 Tags: Emergency Medicine Source Type: forums
USAP Seattle
Can some one please shed some light on the current situation at Swedish? (Source: Student Doctor Network)
Source: Student Doctor Network - February 28, 2024 Category: Universities & Medical Training Authors: pro-propofol Tags: Anesthesiology Source Type: forums
Maryland dentist causes anesthesia overdose death (with a twist)
Maryland oral surgeon convicted of murder in death of girlfriend who overdosed on anesthetic drugs
"He watched her deteriorate before his eyes," the prosecutor told jurors.
www.cbsnews.com
"An autopsy found that Harris died of intoxication from ketamine, propofol and diazepam."
Ryan faces a maximum of 55 years in prison
I'm assuming he got these drugs from his dental office. (Source: Student Doctor Network)
Source: Student Doctor Network - August 30, 2023 Category: Universities & Medical Training Authors: coffeebythelake Tags: Anesthesiology Source Type: forums
Is an EGD w prop GA or MAC
ASA says GA is no purposeful response w deep stimulation. This would make Every EGD and colon I adminster Anethesia for a GA. That being said articles such as the one below refer to Prop anesthesia for EGD as a MAC. What are all you jedi referring to prop induced unconsciousness with no GAG from prop, GA or MAC????
Sedation for routine gastrointestinal endoscopic procedures: a review on efficacy, safety, efficiency, cost and satisfaction
Most gastrointestinal endoscopic procedures are now performed with sedation. Moderate sedation using ben...
Source: Student Doctor Network - August 14, 2023 Category: Universities & Medical Training Authors: turnupthevapor Tags: Anesthesiology Source Type: forums
Pharmacodynamics, Pharmacokinetics, and jaw thrusts
Still, after all these years, I am surprised about the huge variability from patient to patient (kinda like every time I do a spinal, I’m shocked it actually works…spinal = magic).
ASA1 45 y/o for a circ under MAC.
2 mg midazolam makes him sleepy. 50 mcg of fentanyl makes him arousable to voice with a significant shoulder tap. I’m thinking, this guy is a lightweight. My plan was to give 50mg propofol before the penile block and glans penis local (I mean, holy crap, give me the whole stick...
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Source: Student Doctor Network - April 27, 2023 Category: Universities & Medical Training Authors: epidural man Tags: Anesthesiology Source Type: forums
pre-gastric bypass egds
average patient in my city is around bmi of mid 30s. Patients coming in for pre-gastric bypass egds routinely encountered have BMIs in 50s and 60s. I think this may be the most dangerous elective procedure we do. No glidescope or anesthesia machine in room. No syringe or alaris pump, manual propofol pushes. Done in a small endo suite far away from the ORs. Despite preoxygenating and running them lighter, using POM NRB, rapid desats are common. Was told by a partner that there was a bad...
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Source: Student Doctor Network - March 15, 2023 Category: Universities & Medical Training Authors: TheLoneWolf Tags: Anesthesiology Source Type: forums
Intraop shivering? seizure?
How do you tell the difference between intraop shivering vs seizure for patient under GA, with no eeg?
I had a patient the other day , hit his head, bleed, requiring craniectomy. During closure suturing at the end of surgery, surgeon says 'patient is shivering'. i could tell from the monitors (EKG, pulse ox), and i looked over drape and patients entire body is just shivering rapidly.
this patient is under GA propofol infusion, with paralysis (i guess it partially wore off), esophageal...
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Source: Student Doctor Network - February 28, 2023 Category: Universities & Medical Training Authors: anbuitachi Tags: Anesthesiology Source Type: forums
Marijuana Associated with Needing More Anesthesia
Curious what you guys think:
What Doctors Are Learning About Marijuana and Surgery
People who use cannabis may need more anesthesia during procedures, but many remain wary of mentioning their habit.
www.wsj.com
A recent 2023 review:
Contemplating cannabis? The complex relationship between cannabinoids and hepatic metabolism resulting in the potential for drug-drug interactions - PubMed
The majority ...
Source: Student Doctor Network - February 8, 2023 Category: Universities & Medical Training Authors: Lawpy Tags: Anesthesiology Source Type: forums
Propofol waste
Our administration is trying to push a policy that requires wasting propofol similar to how we waste narcotics (requires a witness, etc)
Given the negative affects on workflow (especially in GI) as well as the complete lack of accuracy when wasting when using propofol drips, etc...I am pushing back.
Additionally it will just become a wasted exercise as the nurses will just be blindly witnessing because they won't be familiar with dosing, etc.
I wanted to ask if anyone here currently has...
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Source: Student Doctor Network - January 28, 2023 Category: Universities & Medical Training Authors: UscGhost Tags: Anesthesiology Source Type: forums
Sedation protocols for RFA/rhizotomy
In med school/residency, 5-10 years ago we did these with a wiff of versed and copious local in the office.
New pain guys want essentially a motionless field, GA without an airway/ deep heavy propofol sedation in the OR.
Sometimes they are just too fat or sick and there is no way to make this happen.
Couple weeks back had a BMI 50 anxious chronic pain patient for bilateral c3-5 RFA. Usually I’d just tell pain guy I’m going to give a wiff of versed and deal with it. they expect more...
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Source: Student Doctor Network - January 17, 2023 Category: Universities & Medical Training Authors: DocMcCoy Tags: Anesthesiology Source Type: forums
Status Migrainosus
Anyone ever use propofol in these patients?
There are a spat of studies showing bolusing small doses of propofol can help. I've been angling to do this...and finally did the other day.
This 38 yo F has a history, per the neurologist, of intractable migraines that may be due to PRES she suffered from many months ago. So I'm not totally sure if she had true migraines or some other HA from PRES. Anyway she is in the convalescent phase and for the past few months but still suffering from...
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Source: Student Doctor Network - June 20, 2022 Category: Universities & Medical Training Authors: thegenius Tags: Emergency Medicine Source Type: forums
Remimazolam vs Propofol
https://bmcanesthesiol.biomedcentral.com/track/pdf/10.1186/s12871-022-01713-6.pdf
Interesting trial. In my opinion, as long as respiratory depression is not 0, you still need an anesthesiologist administering. Could be a useful drug, but the lack of time difference when compared to propofol means it'll just be an expensive analogue.
Data from 77 patients were analysed. The success rate of sedation in both groups was 100%. The time
to LOC (MOAA/S score ≤ 1) in the RT group was...
Click to expand...
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Source: Student Doctor Network - June 19, 2022 Category: Universities & Medical Training Authors: Ronin786 Tags: Anesthesiology Source Type: forums
#Case_14 Acute Abdomen and collapsed after induction.
Hi SDN Anesthesiologists,
I hope you are doing well. Bringing in this general forum, this case : 67 years old man with suspected Acute Abdomen - bilateral air under diaphragm. He was with - ve PMH and PSH, but noticeable moderate goiter (no treatment and no investigation). Mallampati 4. His vitals were Bp 240/140 mmgh and PR 126 bpm, SPO2 95%, RR > 20. Had 1 Lt crystaloid in the ER.
Then his BP rechecked again and it was 189/97. We agreed to RSI. Ketamine was given 30 mg, Propofol...
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Source: Student Doctor Network - June 9, 2022 Category: Universities & Medical Training Authors: DrAmir0078 Tags: Anesthesiology Source Type: forums
Stage 2 with propofol infusion?
Resident here. Can you theoretically go through stage 2 with propofol infusion or do those stages only apply to volatiles? Thanks! (Source: Student Doctor Network)
Source: Student Doctor Network - March 22, 2022 Category: Universities & Medical Training Authors: icecoldstar Tags: Anesthesiology Source Type: forums
Propofol induced myoclonus?
Anybody ever seen this? I seem to always get the weird anesthesia reactions that never happen to anyone else.
I was doing moderate sedation on this lady in her 60s, ASA 3, s/p total left shoulder about 1.5 months ago and the orthopod sent her in after doing an XR in the office that showed prosthetic dislocation. I do all my usual pre-sedation assessment, get everything ready, yada yada. All my back up stuff in the room, ortho talks rads into rolling a c-arm down from the OR and we're ready...
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Source: Student Doctor Network - March 7, 2022 Category: Universities & Medical Training Authors: Groove Tags: Emergency Medicine Source Type: forums
