For the past 9 months or so, we have been using Propofol alone for sedation for our outPt bronchs. It works great: compared to Versed there is no need for very high doses in chronic Benzo users, it also causes good amnesia and when you are done they wake up very quickly minimizing turn-around time.
What regimens have you been using for sedation for bronchs?
And as a follow-up question for those who may have used Propofol for that, in TN its administration outside of the ICU is limited to use by physicians or CRNAs. Have you encountered any limitations to use of Propofol for conscious sedation?
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Propofol seems like quite an expensive solution, especially with some of the adverse effects such as myocardiac depression and pancreatitis to name a few.
We use versed and morphine. Versed is also short acting and has amnesiac properties (actually anything that is an agonist for GABA that crosses the blood brain barrier will have this effect since it stimulates the GABAergic system in the hypocampus - short term memory center but I digress).
Well, it is unlikely that peolpe will get pancreatitis (listed as <1% on PI) from the hypertrygliceridemia after a single IV push of Propofol done once but I guess it is possible. Morphine and Versed combined can also cause hypotension. Though Versed is "short-acting" many elderly patients get confused and either remain sedated longer after the procedure or get paradoxical responses. I had seen plenty of both responses at the VA.
Now with regards to cost, it does depend on what you already use: I asked one of our clinical pharmacists and it looks like on our current hospital contract, a 20ml vial of Propofol (all we use) is $3.63; with 5mg of Versed at $1.40 and 100mcg of Fentanyl at $2.60, it's kind of breaking even for us.
Well we use morphine which is cheaper than fentanyl. Also, the propofol is much shorter half life than versed, so don't you need a continuous drip? Also, I woul feel a little leary with propofol if the patient is not intubated.
Well, we are in the airway during the bronch so they can be intubated pretty readily but since we started using it we have not had to intubated anybody.
and you titrate a continuous drip during the bronch?
No, we give a first bolus, they go to sleep and sometimes they will need a smaller second bolus midway through. We have not kept stats on average dose but we can do the whole bronch with less than 200 mg (20ml) in the vast majority of cases and they don't wake up midway through like it happens sometimes with Versed.
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