Most propofol you've ever given on induction...?

[CodeBlu]

I gave 600 mg to get this guy down.... with fentanyl 400 mcg, 2 mg midazolam....

Something is happening here. No way some guy chews up 600 of propofol just because he likes to drink. And I pushed the first one relatively slow. But, when he was still awake... no eye roll or "stare" then I just blasted the next one in.... waited... nothing... blasted the next one in... waited... and finally we won.

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[Urzuz]

Something to consider -- a couple months back I had the same thing happen, albeit I needed to use close to 350 mg to get a regular sized lady down. I looked at the vials of propofol and they were set to expire within a couple weeks of when I used them. This happened again later that same day. In my experience, the efficacy can be related to how close to expiration the drug is. Saving the vials from which you drew the drug up can be very helpful in a situation like this...or at the very least glancing at the expiration date as you're drawing it up.

 

[powermd]

I gave 600 mg to get this guy down.... with fentanyl 400 mcg, 2 mg midazolam....

Something is happening here. No way some guy chews up 600 of propofol just because he likes to drink. And I pushed the first one relatively slow. But, when he was still awake... no eye roll or "stare" then I just blasted the next one in.... waited... nothing... blasted the next one in... waited... and finally we won.

Was he on benzos, barbs, and/or anticonvulsants?

The toughest guy I ever encountered had a seizure disorder and was on barbs and lots of anticonvulsant. He was having some ortho procedure with an apparently good block, but who was getting restless and moving. I had him on a propofol drip and pushed in 500 mg in boluses over about 3-5 minutes trying to get him down. Added 250 of fentanyl, all our midazolam... still restless and moving around. Eventually we pushed sux and popped in an LMA. We even put him on the vent for a while. I had a European attending that day who was more comfortable with that than our American ones.

 

[Mman]

I gave 600 mg to get this guy down.... with fentanyl 400 mcg, 2 mg midazolam....

Something is happening here. No way some guy chews up 600 of propofol just because he likes to drink. And I pushed the first one relatively slow. But, when he was still awake... no eye roll or "stare" then I just blasted the next one in.... waited... nothing... blasted the next one in... waited... and finally we won.

I turn on the sevo long before I get to 600 mg and finish them with inhalation induction.

 

[divinemsm]

In patients who are not cardiac cripples-I routinely use 400 mg of propofol for induction and direct laryngoscopy.

 

[deleted162650]

In patients who are not cardiac cripples-I routinely use 400 mg of propofol for induction and direct laryngoscopy.

Are you not giving any other drugs along with the prop? No narcotic, or paralytic?? I could maybe see 400mg if that was your sole induction agent but with some narc and relaxant thrown in there 400mg is very unnecessary. I think most would agree there are better ways to skin this cat.

 

[Twiggidy]

In patients who are not cardiac cripples-I routinely use 400 mg of propofol for induction and direct laryngoscopy.

 

[dhb]

400mg

 

[Planktonmd]

In patients who are not cardiac cripples-I routinely use 400 mg of propofol for induction and direct laryngoscopy.

WTF!!!

 

[jwk]

Since nobody has mentioned it yet - you have to at least consider that your IV is infiltrated. It's impressive how much fluid/drug can get into the subQ tissues and the area not appear to be swollen.

 

[IlDestriero]

8mg/kg for induction and and infusion @ 450 for a radiation treatment.

 

[btbam]

For peds audiology we routinely run drips at 250-300

 

[Arch Guillotti]

In patients who are not cardiac cripples-I routinely use 400 mg of propofol for induction and direct laryngoscopy.

 

[scudrunner]

Since nobody has mentioned it yet - you have to at least consider that your IV is infiltrated. It's impressive how much fluid/drug can get into the subQ tissues and the area not appear to be swollen.

I was thinking the same thing. Been there.

 

[Spinach Dip]

5000mg

Zoo vets have all the fun.

 

[pgg]

Are you not giving any other drugs along with the prop? No narcotic, or paralytic?? I could maybe see 400mg if that was your sole induction agent but with some narc and relaxant thrown in there 400mg is very unnecessary. I think most would agree there are better ways to skin this cat.

For young healthy outpatients that have LMA written all over them, my preference is to use only propofol & lidocaine for induction. Opiate only makes them apneic longer. I avoid preop midazolam unless they look anxious. I start with about 250-300 mg but some need more.

 

[narcusprince]

Pgg,
I used to be in that camp of non narcotic placement of LMAs but after doing some lithotripsy cases my cocktail has been 50 mcg when the patient hits the room then 2 mg/kg to 2.5 mg/kg of prop then LMA placement. Lithios are great in that you know exactly when the surgeon is done cases roughly 20-35 minutes. No issues with this approach and lma placement. In addition im also using nitrous/o2 50/50 with sevo and have yet to see ponv....... Return of the mac(quoting a song) of nitrous! 600mg sounds like an infiltrated IV or time to add a little inhaled agent. Those EOD guys would be in the 3mg/kg range too.....

 

[deleted162650]

For young healthy outpatients that have LMA written all over them, my preference is to use only propofol & lidocaine for induction. Opiate only makes them apneic longer. I avoid preop midazolam unless they look anxious. I start with about 250-300 mg but some need more.

Ya I don't give any narc for my LMA inductions either but his post specifically said "induction and direct laryngoscopy"

 

[Mman]

For young healthy outpatients that have LMA written all over them, my preference is to use only propofol & lidocaine for induction. Opiate only makes them apneic longer. I avoid preop midazolam unless they look anxious. I start with about 250-300 mg but some need more.

For those patients I give maybe 100-150mg of propofol and then get them deep with sevoflurane. Keeps them breathing spontaneously essentially the entire time. As soon as the LMA is in you can just let them keep breathing.

 

[leaverus]

600 is the most I've given for a single induction also. if i recall, 30ish something guy otherwise healthy for cystoscopy.

 

[Random Anesthesiologist]

I've done some colonoscopies on alcoholics on pain meds. Propofol up toward 1000mg to make them comfortable, breathing easy. I couldn't believe it, but one in particular has had serial scopes and required a little more each time. No residual effect in pacu.

 

[Phyzicz]

for our pain procedures on chronic high dose pain patients propofol in the high hundreds (600-700s) and midazolam in the double digits does nothing but make them stop moving for a few seconds to a minute to get a few needles in. Spont vent the entire time.

 

[Twiggidy]

Return of the mac(quoting a song)

Well done...

 

[Laryngophed]

A recent grad of my program gave 800mg and finished 'em off with the mask.

 

[Guy Caballero]

A recent grad of my program gave 800mg and finished 'em off with the mask.

Yep, 800mg of propofol will finish off most patients.

 

[divinemsm]

As a heart attack-which has never happened in the qualifier patient type I mentioned . I also don't paralyze people routinely unless with sux if concern for difficult airway or full stomach and its equivalents . I am always amazed at how algorithmic people are in their practice. No-surgeons have not complained about " muscle relaxation" and " no twitches".