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Post by Wai-Ling Lo on Oct 26, 2021 14:01:09 GMT -5
Question 1: How do you administer Propofol to patients for induction to prevent pain? Like most of you have mentioned, large bore IV/wide open IV fluid/Fentanyl and lidocaine prior to injection of propofol seem to help.
Question 2: After reading article, will you change your practice of Propofol use? (example mix it with other drugs, syringe reuse and others)? I won't change my current practice. I too learnt about the lidocaine issue in school and didn't mix lidocaine with propofol. I discard used propofol after 6 hours.
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Post by Soo-Ok Kim on Oct 26, 2021 15:31:32 GMT -5
It was great article to review the propofol. Question 1: How do you administer Propofol to patients for induction to prevent pain?
I give lidocaine 30sec to 1min before propofol via larger bore PIV, if possible. There are some case reports indicating Lidocaine can worsen the heart block, even causing CHB, when pt has underlying AV node block since Lidocaine is class 1B antharrythmic. It also may hinder the inducing the rhythm in EP patients who go thru ablation. Because of this concern, I don't normally use lidocaine before propofol and give fentanyl beforehand. Those pt population don't seem to have any issue with the pain related to propofol injection. Also, the pts over 75 yo, I don't usually use lidocaine before propofol and have not experienced any issue with that.
Question 2: After reading article, will you change your practice of Propofol use? (example mix it with other drugs, syringe reuse and others)? I have never mixed propofol with lidocaine and will not change my current practice.
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Post by mary clothier on Oct 31, 2021 19:44:32 GMT -5
1. I give lidocaine prior to induction and tighten the roller clamp in attempt to keep the lidocaine bathing the vein, prior to administration of propofol. I have also added lidocaine to the propofol for many years, it causes less discomfort, w/o sequelae! The distraction techniques are probably most effective prior to LOC!
2.The article will not change my lidocaine/propofol administration practice for induction of anesthesia. The PRIS syndrome is very interesting, it will change my practice with the debilitated, cachexic, and pediatric patient population! The clinical update by Ypsilantis and colleagues is excellent!
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Post by Amy Swank on Nov 1, 2021 11:31:44 GMT -5
1) I usually give lidocaine and then propofol immediately upon the patient walking into the room and lying onto the OR table (since we usually avoid midazolam in ambulatory unless necessary). I would like to try the tourniquet and the lidocaine technique, but usually production pressure does not allow for the lidocaine to dwell intravenously before propofol administration. If I were to give some versed to the indicated anxious patient, I will try it, especially if I know an attending is not immediately available for induction and/or the IV is placed in the hand (which is always more pain-inducing for these patients.
2) I have stopped putting lidocaine and propofol in the same syringe for years now, and found the science behind it in this article helpful in the explanation of it. I would still administer ketamine and propofol together especially since the journal article didn't really advise against it. I will be on the look out for some Lily Pulitzer themed urines though (pink, green and white) Don't really have the opportunity to see too many foley bags since they are usually removed at the end of the case, or understandably bloody with cystoscopy cases.
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nanci
Junior Member
Posts: 57
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Post by nanci on Nov 1, 2021 13:12:47 GMT -5
1) How do you administer Propofol to patients for induction to prevent pain? I give Lidocaine prior to propofol and either Midazolam or Fentanyl as well. Sometimes give 1-2 cc propofol, let that go in, then give the rest of the medication for induction (rest of propofol).
2): After reading article, will you change your practice of Propofol use? (example mix it with other drugs, syringe reuse and others)? May be more aware if other medications are still in line. I am not in the practice of mixing Propofol with any other medications and do not reuse syringes.
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