propofol for DTs?

[Intubate]

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I just got an email from one of our ICU guys that they want to institute an alcohol withdrawal protocol that involves intubation and propofol infusions. I did a quick search and didn't find much more than some case reports. Anyone have a similar protocol at their institution?

 

[lord_jeebus]

Why propofol instead of a benzo?

 

[Jay K]

No such protocol in our hospital to my knowledge.

Do they want the anesthesia department to be involved in said treatment plan?

 

[fakin' the funk]

Why propofol instead of a benzo?

Quick offset? ...Although I suppose you don't really want a quick offset for DTs.

I've heard of a protocol involving a single pentobarbital bolus: peak effect when symptoms are peak, and then a tail when symptoms are subsiding. Never seen it though.

 

[idiot07]

Anecdotally, I've used propofol gtt's temporarily in intubated DTing patients that were absolutely flipping out just to get them under temporary control and allow the ativan time to catch up. Then they were switched over to an ativan gtt for maintenence and taper.

I thought the hot new drug for DT's is precedex, as supposedly you can avoid intubation with it more often. We've never used it for this in our institution, but I'd like to try.

 

[mlw47]

Forr a really great podcast on the issue, and for really great lectures on other topics too, check out: http://emcrit.org/podcasts/delirium-tremens/


I have no financial interest in this guy's work. But as a student I think it rocks.

 

[amyl]

precedex rocks for this too. we do propofol as well but tube is optional if dose is low enough.... ICU only of course.