Little bits of the propofol stopper
I currently usually use a standard 16G needle to draw up propofol (haven't seen those "spikes" since residency) and once in a while I'll see a tiny gray piece of the rubber vial stopper in the drug that I've drawn up. I'll then either try to squirt the piece out or toss the entire syringe. But I wonder how many times I miss some small (or even microsopic) fragments of rubber that are being injected intravenously. Anyone else notice this? What do I do without those spikes that have the...
Little bits of the propofol stopper (Source: Student Doctor Network)
Source: Student Doctor Network - June 6, 2020 Category: Universities & Medical Training Authors: leaverus Tags: Anesthesiology Source Type: forums
Pediatric dosing
I am in PP and most of my colleagues use only sevoflurane for bmt & adenoids - very rarely use propofol or fentanyl. I normally induce with gas, use 2mg/kg propofol to intubate and titrate in 1mcg/kg fentanyl before case in done. Sometimes I even use up to 4mg/kg in older kiddos if they’re light when I go to put the tube in. I’ve been told by multiple more senior colleagues that might be too much. What do other folks do?
Also, full disclosure these cases are 15-20 minutes at most.
Thanks. (Source: Student Doctor Network)
Source: Student Doctor Network - May 31, 2020 Category: Universities & Medical Training Authors: pinkMD12 Tags: Anesthesiology Source Type: forums
Quick prone MAC colorectal cases: what do you use?
Recently out from residency into private practice. We didn’t do these prone cases (fistula, hemorrhoids, etc) much in residency. I was just curious what you all do for them. Seems like the only painful part is the local injection. So I was thinking maybe versed and propofol would be best, but was also thinking of using remifentanil? Seems like it would wear off faster that propofol if patient went apneic. The operating time for these cases is usually less than 5 minutes. (Source: Student Doctor Network)
Source: Student Doctor Network - November 24, 2019 Category: Universities & Medical Training Authors: NoTalentGasClown Tags: Anesthesiology Source Type: forums
Propofol use by EM physicians
An argument had started in our hospital system regarding our insistence that the ED use moderate sedation using ketamine/versed/fentanyl/? etomidate? for joint manipulation/setting fractures/etc.
They want to use propofol for "deep sedation". Which, in discussion, is obviously general anesthesia. As most know, EM's NPO standards are much more lax than ours.
I know ultimately it's more important what the depth of sedation is, but I also feel like propofol gives them a slippery slope.
I'd...
Propofol use by EM physicians (Source: Student Doctor Network)
Source: Student Doctor Network - October 30, 2019 Category: Universities & Medical Training Authors: WDP05 Tags: Anesthesiology Source Type: forums
Intense vagal episode with induction
Healthy mid aged woman, premeditated with versed, fentanyl, lidocaine, then after propofol was pushed gasped a bit, to bradycardia and then went asystolic for 12 seconds. Recovered spontaneously while we were scrambling for epi, atropine and preparing to perform chest compressions. We subsequentlg gave 0.4 mg glycopyrrolate and 15 mg ephedrine. Remained stable after, we continued with induction and did the case.
Anyone have similar experiences with propofol? (Source: Student Doctor Network)
Source: Student Doctor Network - June 28, 2019 Category: Universities & Medical Training Authors: eikenhein Tags: Anesthesiology Source Type: forums
Hiccups during endoscopy
Anyone have any advice for treating hiccups during endoscopy (assume patient is adequately sedated with propofol). It happens infrequently and typically resolves within a few minutes- but very annoying when it occurs during a critical part of a case! (Source: Student Doctor Network)
Source: Student Doctor Network - June 23, 2019 Category: Universities & Medical Training Authors: VaporMD Tags: Anesthesiology Source Type: forums
Palliative sedation?
As a nursing student, during one of our rotations I noticed that a lot of stage 4 cancer patients/ terminally ill patients were sedated with anesthetics such as midazolam or propofol and they referred to it as "paliative sedation." We were told that the two most common reasons for the sedation are due to persistent/ treatment resistant pain or nausea/vomiting.
I understand how sedation can help the pain because you cannot feel pain if you are asleep, but how does it help with...
Palliative sedation? (Source: Student Doctor Network)
Source: Student Doctor Network - April 10, 2019 Category: Universities & Medical Training Authors: NurseDude1966 Tags: Hospice and Palliative Medicine Source Type: forums
Propofol shortage
In the spirit of opioid shortages, what would you do if there was a propofol shortage? I'm curious of people's plans for various anesthetic scenarios. (Source: Student Doctor Network)
Source: Student Doctor Network - April 21, 2018 Category: Universities & Medical Training Authors: ethilo Source Type: forums
IV anaesthetics
Here was a question in u world stating that the drugs which are soluble in blood takes more time for their onset of action and even large amount of drug is required for induction,saying that PROPOFOL which is highly lipophilic drug has very rapid onset of action. considering above two statements together propofol will rapidly distribute itself into tissues ,so how can it have rapid onset?
inputs are highly appreciated ,thank you (Source: Student Doctor Network)
Source: Student Doctor Network - April 7, 2018 Category: Universities & Medical Training Authors: Blind date18 Source Type: forums
Physostigmine for propofol reversal
Has anyone heard of using 1 mg of physostigmine to reverse the effects of propofol? I tried it based on anecdotal evidence from a colleague. What are your thoughts? (Source: Student Doctor Network)
Source: Student Doctor Network - March 31, 2018 Category: Universities & Medical Training Authors: timgasman Source Type: forums
Propofol dosing for TIVA
I’m curious how low people go on their propofol dosing for TIVA, especially in cases where you can’t put a BIS on and your not paralyzed. Lowest Ive ever gone with a continuous sufenta infusion was 90 mcg in an older guy that was somewhat sicker, but the guy did move once towards the end of the surgery.
Also, where do people usually start their propofol dosing for TIVAs? (Source: Student Doctor Network)
Source: Student Doctor Network - March 29, 2018 Category: Universities & Medical Training Authors: dipriMAN Source Type: forums
NPO, ERAS, Total joints
What are you guys doing for total joints in terms of NPO/ERAS?
We recently started having the patients take 32oz Gatorade a few hours before the procedure and I've started seeing some cases of regurgitation during our spinal/50mcg/kg propofol anesthetic.
Really wasn't having issues with this before and I'm thinking clears prior to surgery is one thing and 32oz of clears with high glucose load is another.
What do you guys think? (Source: Student Doctor Network)
Source: Student Doctor Network - March 6, 2018 Category: Universities & Medical Training Authors: facted Source Type: forums
Would the use of Precedex expand the group of non-anesthesiologist from administered deep sedataion?
The profile of precedex is such that respiratory drive is preserved unlike propofol, fentanyl, ketamine, and midazolam. Yet it still provides sedation, hypnosis, and analgesia.
Would it be fair to speculate that a more generalized use of precedex and the expiration of its patent in 2019 (current cost is $40/vial) driving its cost down will possibly make it dummy proof to the extent that providers like periodontist could safely administer deep sedation in their office? (Source: Student Doctor Network)
Source: Student Doctor Network - February 26, 2018 Category: Universities & Medical Training Authors: GCS8 Source Type: forums
Ketamine during a Bronchoscopy
So I'm a CA-1 and aware that I'm still a rookie in anesthesia. I've been taught in lecture/read in books that when you use ketamine you should anticipate an increase in salivation usually helped with the administration of Robinul. I was in a bronchoscopy last week when I saw an attending use a mixture of propofol and ketamine on microdrip tubing along with an LMA as the airway. He didn't use any Robinul even when the RN at bedside continually suctioned the mouth. I know that with all the...
Ketamine during a Bronchoscopy (Source: Student Doctor Network)
Source: Student Doctor Network - January 14, 2018 Category: Universities & Medical Training Authors: DeadSpace Source Type: forums
