propofol and PONV

[epidural man]

does anyone ever use a small dose propofol infusion in the PACU for refractory PONV that doesn't respond to drugs/P6/isoproply alcohol on the nose, etc?

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[VolatileAgent]

does anyone ever use a small dose propofol infusion in the PACU for refractory PONV that doesn't respond to drugs/P6/isoproply alcohol on the nose, etc?

pacu? no. the anti-emetic effect pretty much wears off with the sedation effect. and, unless you're willing to sit in the pacu with the patient and continuously float a little in, it's not worth the trouble. plus, you've got to watch out for the pitfall of oversedation which leads to respiratory depression, bag-masking, and possibly re-buying the tube.

my advice? don't do this in the pacu. stop the narcs, load 'em up on a 5-ht3, add in a little promethazine and, if all else fails, 0.625 of droperidol.

 

[Planktonmd]

does anyone ever use a small dose propofol infusion in the PACU for refractory PONV that doesn't respond to drugs/P6/isoproply alcohol on the nose, etc?

In my experience when you are dealing with refractory PONV you can give small doses of Propofol once or twice and that usually works, there is no need for an infusion.
It's perfectly safe to do as long as you know what you are doing.

 

[epidural man]

In my experience when you are dealing with refractory PONV you can give small doses of Propofol once or twice and that usually works, there is no need for an infusion.
It's perfectly safe to do as long as you know what you are doing.

Yeah, I have never used it as a bolus because I was under the impression that the effect was only 6 minutes or so. Maybe the effect is longer because of the concept of hysteresis - a concept I think that applies to a lot of what we do in anesthesia, but I have never heard any one really mention anything about it.

 

[VolatileAgent]

Yeah, I have never used it as a bolus because I was under the impression that the effect was only 6 minutes or so. Maybe the effect is longer because of the concept of hysteresis - a concept I think that applies to a lot of what we do in anesthesia, but I have never heard any one really mention anything about it.

i once gave a "pure propofol" (ie, absolutely no other meds) anesthetic to an elderly woman with multiple co-morbidities undergoing an EGD. she had 3 episodes of dry heaves in the recovery area before i was called over and had the chance to give her a real anti-emetic. i sure as hell wasn't going to give her any more propofol.

 

[Noyac]

I use propofol in the PACU when I come across a pt who has had eveything and is still nauseated. But only 20mg or so. It works immediately and it seems to last, at least long enough to get out of the PACU.

 

[VolatileAgent]

...at least long enough to get out of the PACU.

you or the patient?

 

[Noyac]

you or the patient?

Does it matter?

 

[The_Sensei]

Does it matter?

Allow me to answer this for all the residents and new attendings....

The answer is NO.

 

[VolatileAgent]

Allow me to answer this for all the residents and new attendings....

The answer is NO.

so, if they vomit an hour later, it's not your fault?

 

[The_Sensei]

so, if they vomit an hour later, it's not your fault?

Right

 

[VolatileAgent]

Right

and you always go back and check the chart to write a note correcting the primary service assessment of "anesthesia-related post-operative vomiting" stating, in fact, that it wasn't your fault... right?

 

[bostonblaz]

i have found that it works best for women who have just delivered under regional anesthesia and they are complaining of nausea from the pit they are getting iv, 5-10 mg bolus prevents me from getting puked on.

 

[Noyac]

i have found that it works best for women who have just delivered under regional anesthesia and they are complaining of nausea from the pit they are getting iv, 5-10 mg bolus prevents me from getting puked on.

Pit causes nausea! Really?

I thought it was the externalized uterus. Along with causing chest pain and shoulder pain.

But I use it in this cenario as well.