Weird Response to Propofol

[AngelofHysteria]

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[LetItSnow]

1) SDN isn't for medical advice. I'm betting the mods will lock this.

2) Any drug can have an adverse reaction to it. I haven't personally seen paradoxical excitement to propofol, but I'm sure it happens.

3) Recommendation: Don't think of scruffing as ideal/acceptable/first-choice. It's stressful for the cat, and leads to worse interaction. Is it a necessary evil sometimes? I think so. Some DVMs disagree. But it definitely shouldn't be "cus its better be safe than sorry."

4) Recommendation: If you are pre-vet and planning on a DVM, no time to start learning like the present: dosages are never, ever, ever in CCs or MLs (except for fluids like crystalloids, colloids, etc.). Those are volumes. Dosages are in mg (or similar appropriate measurement) or mg/kg (or similar appropriate measurement). A CC or ML is just a volume, it does not inherently represent how much medication you gave. Propofol is for now standard at 10mg/ml, but it might not always be that way and there's always the chance with most drugs for different concentrations commercially, or compounding, or whatever. Might as well start referring to meds appropriately now. You gave (presumably) 10mg, not 1cc, before the cat went bazonkers. (You stumbled into one of my pet peeves as a referral veterinarian - receiving records from another vet where they write something like "gave 0.6ml buprenorphine" which does me no good because even in our hospital I have different concentrations of that drug - so I have no way to know how much was given. Medication administration always includes Med/Dose (in mg or mg/kg or other med-appropriate dose)/Route/Time.)

G'luck.

 

[dyachei]

in cats especially, propofol can cause excitation and is not a bizarre response at all. They often transition out of that phase quickly.

 

[LetItSnow]

in cats especially, propofol can cause excitation and is not a bizarre response at all. They often transition out of that phase quickly.

Huh. In your experience, does administration rate have anything to do with it? I use propofol in cats on, like, a daily basis, and I've never had paradoxical excitement. But I'm a believer in pretty slow administration (I've also not once experienced apnea from it.)

 

[dyachei]

Huh. In your experience, does administration rate have anything to do with it? I use propofol in cats on, like, a daily basis, and I've never had paradoxical excitement. But I'm a believer in pretty slow administration (I've also not once experienced apnea from it.)

It has more to do with if you pre-med or not. It's usually the cats where you don't premed that show it. It also happens with gas anesthetics. Slow administration does help. But some cats are just special. Especially hyped up young ones

 

[LetItSnow]

It has more to do with if you pre-med or not. It's usually the cats where you don't premed that show it. It also happens with gas anesthetics. Slow administration does help. But some cats are just special. Especially hyped up young ones

Huh. Weird. I often use it without any premed. Maybe it's partly a compromised/sick vs healthy thing as well.

Ah well. Good to know.

 

[DVMDream]

I've seen the excitement thing from propofol too, but only in dogs.

 

[LetItSnow]

You all gotta quit using that knock-off brand.

 

[rdc]

Huh. Weird. I often use it without any premed. Maybe it's partly a compromised/sick vs healthy thing as well.

Ah well. Good to know.

Under what circumstances would you be inducing GA without using a premed?

 

[LetItSnow]

Under what circumstances would you be inducing GA without using a premed?

We do it fairly often with a compromised patient (usually they do have at least an opioid on board, though, so I suppose you could argue that's a premed). Regularly but infrequently we'll do it on a very fractious hospitalized patient that can't be examined or handled otherwise but for whom we don't want other medications on board. We'll do it for patients with other non-painful (or minimally paintful) quick procedures where we want the patient not moving around.

Just last week we did it for a bone-around-the-jaw patient who just wouldn't quit fighting. Non-painful, don't really want or need other typical pre-meds on board once the procedure is done, propofol is safe, and you know the procedure will be quick. Works well for getting them down quick, back up quick, and out the door.

"Often" might be an overstatement. But we do it frequently 'nuff.

 

[DVMDream]

We do it fairly often with a compromised patient (usually they do have at least an opioid on board, though, so I suppose you could argue that's a premed). Regularly but infrequently we'll do it on a very fractious hospitalized patient that can't be examined or handled otherwise but for whom we don't want other medications on board. We'll do it for patients with other non-painful (or minimally paintful) quick procedures where we want the patient not moving around.

Just last week we did it for a bone-around-the-jaw patient who just wouldn't quit fighting. Non-painful, don't really want or need other typical pre-meds on board once the procedure is done, propofol is safe, and you know the procedure will be quick. Works well for getting them down quick, back up quick, and out the door.

"Often" might be an overstatement. But we do it frequently 'nuff.

C-section.... seen it before where given no premed (or minimal) because don't want puppies/kittens sedated, propofol IV, quickly cut, get em out then appropriate pain control can be started once all puppies/kittens out.

 

[LetItSnow]

C-section.... seen it before where given no premed (or minimal) because don't want puppies/kittens sedated, propofol IV, quickly cut, get em out then appropriate pain control can be started once all puppies/kittens out.

Yeah. Meh. There's not really agreement on that one. I personally do give them opioids, and have never had a problem. But I do know there are docs on the other side of the equation that don't do it.

But yeah, definitely a situation where some people would do it without premed.

 

[DVMDream]

I personally do give them opioids,

C-section.... no premed (or minimal)

Got you covered too. It was just the most classic example I could think of for minimal to no pre-med.

 

[jmo1012]

Under what circumstances would you be inducing GA without using a premed?

Euthanasia - I've seen excitation in both species with protocol. I anecdotally do think the slower the rate, the smoother the induction with euthanasias, and see it primarily in the not terribly compromised patients.

 

[pinkpuppy9]

This thread simultaneously makes me happy but also makes my eye twitch since I just covered all of this in my anesthesia lectures.

 

[LetItSnow]

Euthanasia - I've seen excitation in both species with protocol. I anecdotally do think the slower the rate, the smoother the induction with euthanasias, and see it primarily in the not terribly compromised patients.

Ha! I didn't even think of euthanasia, and I give propofol (first, separately - I know some vets who mix the propofol/euthasol) to most of my euthanasias. If they're severely compromised I don't do it, but if it's an alert/etc patient I do.

 

[LetItSnow]

Ha. Another example: Just right now had a squirmy, mildly fractious constipated cat. Sedated with propofol for the deobstruction. No pre-med. Works great. I personally would rather do that where I know my technicians are safe and the cat isn't freaking out / anxious / scared throughout the procedure.

I'm not <against> premeds (obviously - I use them all the time), I just think they need a purpose. You don't always need the sedation, or the analgesic, prior to the propofol.