October FY 22

[clawry]

This month's journal club article is presented by Katya Podin, CRNA. The article is titled Propofol: Clinical Concerns, Curiosities, and Caveats Part 1. This article discusses the risks of adding medications such as lidocaine to propofol. The article also reviews other common risks and potential complications of propofol use.

Here is a link to the article. 

Please answer these questions on the discussion board after reading the article:


Question 1: How do you administer Propofol to patients for induction to prevent pain?


Question 2: After reading article, will you change your practice of Propofol use? (example mix it with other drugs, syringe reuse and others)?

[clawry]

Question 1: How do you administer Propofol to patients for induction to prevent pain?


I administer propofol into a large bore IV with fluids running wide open. I administer lidocaine in a separate syringe 30 seconds prior to propofol administration to blunt the vein irritation. I have always kept the lidocaine in a separate syringe. We discussed the problems of mixing lidocaine with propofol in anesthesia school, so I have always kept the 2 drugs in separate syringes. 




Question 2: After reading article, will you change your practice of Propofol use? (example mix it with other drugs, syringe reuse and others)?


I will continue my practice of administering lidocaine prior to propofol in separate syringes as to not to change the consistency of the propofol. I appreciate the article Katya! I think that sometimes we take for granted all of the possible complications that can occur from administering propofol since we use it in our daily practice. I have definitely seen the milky white and green urine. One of the anesthesiologists that I used to work with at York used to mention that they may have green urine from the propofol when he obtained consent from his patients.

[LarSharVeA Bailey]

I give lidocaine immediately before giving Propofol. Unfortunately, we do not have the time to use the tourniquet method that's mentioned in the article.

I do appreciate giving lidocaine followed by administration of smaller aliquots of Propofol accompanied by saline flushes; but generally, the burning, when
experienced, is ephemeral thus aside from fentanyl and lidocaine prior, I do not find it necessary to deviate from the status quo.

[kelseyleonard]

1. I administer fentanyl and lidocaine immediately prior to giving propofol. In patients that expressed significant pain on injection with prior anesthetics I administer the lidocaine a few minutes before the propofol in attempt to give it enough time to work.

2. I did find it interesting the studies on how mixing propofol with other medications changes the droplet size and therefore stability. I routinely mix ketamine with propofol for patients with cardiomyopathies. However, the research around 'Ketafol' is not ample enough for me to change my practice. The benefit of this technique outweighs the risk.

[Dahlia Rouchon]

1. To prevent pain on injection of propofol, I try to use large bore PIVs when possible without the J-loop microbore connection tubing as the J loop has a smaller diameter than the PIV tubing and slows the rate of injection increasing pain on injection. I may use the BP cuff as a tourniquet to hold the lidocaine in the vein then release the pressure during propofol injection. I will occasionally inject the propofol at a higher injection port closer to the bag to allow more mixture of IVF and slow the rate of injection after fentanyl is given.
2. I would not change my practice of propofol administration and still administer in separate syringes the lidocaine from propofol.

[kels]

To try to prevent propofol pain I administer propofol after lidocaine administration . Ideally I would give fentanyl a few min prior to giving the lidocaine.

I do not mix multiple drugs in one syringe and I will continue this practice

[Kels]

I also do not reuse syringes in my practice and I will continue this practice

[Katya Podin]

1. I use lidocaine before Propofol and turn stop cock to prevent flush it, so lidocaine followed by Propofol in line. I was told in school not to mix Propofol with lidocaine but was not sure what can happen until I read this article. I don't like to mix any drugs in the same syringe.
2. I will not change my practice. I will keep Propofol from mixing it with other medication.

[Jessica Hadley]

1. My practice is to give fentanyl as soon as we get in the room and then Lidocaine immediately prior to Propofol in separate syringes.

2. I had read this current review before so was already aware of the risk of mixing Propofol and Lidocaine. I also do not reuse syringes, needles, etc.

[Amy Schutter]

1. Currently, I give Fentanyl while applying monitors, then push Lidocaine wait a minute and then proceed with propofol. However, I have in the past mixed my propofol with Lidocaine in the same syringe and after reading this article when it was published in 2019 I changed my practice.
2. I will not change my current practice I will continue to keep my medications in separate syringes

[Anne McNultyCRNA]

If possible I give 25-50- mcg of fentanyl before induction into the largest bore iv available. Unfortunately we frequently have 22 g IV's in Endoscopy , Wilmer and JHOC. I do not use the tourniquet method. I have never seen any one at JHU use that method. I have not mixed propofol with lido in more than 25 years. I have never added ketamine to the lido. Ketamine gets it's own channel on the Alaris. I recently had an attending mix the lido with the propofol. That was during the 20 cc syringe shortage.

[Christine Velarde]

1. I do not mix the propofol with the lidocaine. If possible I'll give the lidocaine then propofol through a larger vein if possible.
2. I will continue to use separate drugs and separate syringes.

[aileenm4]

1. I try to give Lidocaine with a tourniquet method, but most of the time it is Lido IV before the Propofol, with pre med of Versed/Fent and sometimes Dexmedetomidine. AC and largest bore IV are key to helping

2. Propofol is dated and timed, never reused syringes on multiple patients, discard old Propofol, do not mix any meds with Propofol

[Lu Lin]

1: How do you administer Propofol to patients for induction to prevent pain?

I administer propofol into a IV with fluids running wide open. I administer lidocaine in a separate syringe 15 seconds prior to propofol administration to blunt the vein irritation. I have always kept the lidocaine in a separate syringe.




2: After reading article, will you change your practice of Propofol use? (example mix it with other drugs, syringe reuse and others)?

I will not change and continue my practice of administering lidocaine prior to propofol in separate syringes as to not to change the consistency of the propofol.  I think that sometimes we take for granted all of the possible complications that can occur from administering propofol since we use it in our daily practice.

[emedina1]

1)
How do I administer propofol, i usually give lidocaine about 20to 30mg and stop the flow of iv fluid so the drug, linger on the vein a few second and then I give the dose of propofol i intend to give2
2) atter reading this article, I am more convince that I should not mix propofol with any drug at all.