Egg retrievals

[epidural man]

We do a fair number of egg retrieval cases -

We do them under a propofol infusion.

These patients, for what ever reason (which i think is hormonally regulated -- the drugs they get so the ovaries are all swollen and stuff must be the culprit), they take a TON of propofol to put them down...and keep them down.

Has anyone else experienced this?

I haven't seen this written down any where.

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[urge]

I thought it was the big harpoon they are shoving repeatedly down the @$&_).

 

[Jay K]

they take a TON of propofol to put them down...and keep them down.

how much is a ton? mcg/kg/hr-wise? or bolus-wise/time?

 

[epidural man]

how much is a ton? mcg/kg/hr-wise? or bolus-wise/time?

Well, for the last one, after a bolus of 100mg, then running 100mcg/kg/min, she was responsive and acting like she was getting 25-50mcg/kg/min. Routinely they need >300mcg/kg/min to keep them from whining.

 

[Jay K]

Well, for the last one, after a bolus of 100mg, then running 100mcg/kg/min, she was responsive and acting like she was getting 25-50mcg/kg/min. Routinely they need >300mcg/kg/min to keep them from whining.

Interesting, that IS a ****-ton of propofol. How long are the procedures typically? How many ml's propofol do you usually use up in one procedure? Again, just curious.

 

[Hypenosis]

Ever consider splashing 10-15mg of ketamine?

 

[dhb]

Never had such experience i give 5mcg of sufenta + propofol infusion, although at my current gig the gyn infiltrates the vaginal cul-de-sac

 

[Noyac]

Yes, ketamine will help.

 

[epidural man]

Oh no doubt. There are plenty of things to decrease the dose - do the anesthetic, etc. That isn't the point.

I am just commenting on how I think it is so strange that in these particular patients, the propofol requirement seems WAY higher than usual or what could be expected. A quick scholar.google search - I can't find where anyone has specifically looked at this. The only thing different about this cohort of patients is they have very different hormon levels floating around because of the physiological state they are in for maximum oocyte retrieval.

Since we don't know how propofol works, or where it even goes after it is injected, I find it sort of fascinating. It is very strange that this drug (propofol) just completely disappears with no trace.

 

[pjl]

We use a regular dose of remi for these. Didn't you read the single article based on rat studies with a 0.00001% difference in success when propofol was used?

Seriously though, the remi dose is normal range.

 

[deleted9493]

100mcg/kg/m following a bolus with a low dose analgesic should keep most spontaneously breathing and not moving. Yeah, you had better look at adding a second agent, if you want immobility. Ketamine...fentanyl...morphine...little difference, as long as it's given in the appropriate time.