extra-potent propofol?

[IHO]

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just a curious observation. I have been in private practice for 8 years and have been using the same cocktail for office sedations...10 versed, 50 fentanyl, propofol PRN, usualy 30-80mg bolus 3-4 times. rarely I would notice a drop in a pt's BP. Over the past 2 months, I have noticed significant drops almost daily...usually 80s/30s. My cocktail hasn't changed, my patient population hasn't changed but I am noticing A LOT more BP fluctuations than ever before...what gives? anyone else out there w/ similar observations recently??

IHO

 

[Doc Ock II]

Why pick on the propofol if noting has changed? Why not the versed or fentanyl? Maybe try varying your cocktail (as prop is a intermittent infusion PRN). I might suggest 5 versed. And if that isn't sufficient for your sedation consider using another agent (25mg ketamine IVP) adjunct. Ketamine can bump up BP and salivation and still have adequate sedation. And you may need to use less prop(if you really think that is what is causing the low BP, which is really low). Are your patient's too dried out? Does the BP respond to either fluid bolus or surgical stimulus? I have not seen any effects suggesting a super prop. and my normal cocktail are the same agents as yours except less versed sometimes valium (and only ketamine on an as need basis case by case).

 

[mbgandh]

- Inquire about your patients hydration prior to the procedure. Water can be encouraged up to 2 hours before. Can make a significant difference
- Have you changed to a propofol made by a different manufacturer? I've seen some propofols be less potent than others.
- Infusion pump can help stabilize your patients BP's also. Just a thought...

 

[Sublimazing]

- Inquire about your patients hydration prior to the procedure. Water can be encouraged up to 2 hours before. Can make a significant difference
- Have you changed to a propofol made by a different manufacturer? I've seen some propofols be less potent than others.
- Infusion pump can help stabilize your patients BP's also. Just a thought...

How do you know when propofol is less potent?