Posted on 08/09/2022 9:12:38 PM PDT by ConservativeMind
Research involving patients in intensive care has highlighted that propofol, an anesthetic drug commonly used to facilitate invasive mechanical ventilation, increases cardiovascular complications risk in the critically ill.
Dr. John Laffey led a team investigating the causes and impact of peri-intubation cardiovascular instability in critically ill patients.
This research is part of the International Observational Study to Understand the Impact and Best Practices of Airway Management in Critically Ill Patients (INTUBE) which is investigating tracheal intubation in patients.
The investigators identified important modifiable, previously poorly understood risk factors that increase the risk of critically ill patients developing shock and cardiovascular instability when undergoing urgent tracheal intubation to permit invasive mechanical ventilation, commonly referred to as 'life support'.
"Tracheal intubation is one of the most high-risk and frequently performed procedures in patients who are critically ill. Cardiovascular adverse events like low blood pressure and even cardiac arrest can be frequent after intubation. Different factors play a role in the increased risk in patients who are critically ill compared with patients undergoing the procedure for elective surgical procedures."
"To date, the research has mainly focused on oxygenation optimization and on methods to achieve intubation at the first attempt."
"In our research we have identified that the commonly used anesthetic drug—propofol—is strongly associated with an increase in the incidence of cardiac arrest and severe hypotension after intubation."
"It is our intention to reduce the risk and severity or cardiovascular adverse events in critically ill patients requiring urgent tracheal intubation. Our data strongly suggests that propofol use should be restricted in this patient group and even avoided where possible."
"Training in the use of this specialized drug is key. The drug suppresses reflexes which makes it particularly good for intubation, but equally it appears to be this suppression that is causing risks for patients."
(Excerpt) Read more at medicalxpress.com ...
Propofol is an incredibly safe drug when carefully titrated. Since Vanderbilt did it’s seminal work on delirium the most data driven and proper sedation in the ICU setting is analgesic based sedation (fentanyl infusion being the most frequent). This is far more hemodynamically stable. Critical care is usually attended to by pulmonary physicians. Critical care anesthesiologists make up about 1/4 of the Intensivist’s and are well trained in handling these potent medications. For the shock patient, ketamine infusions are quite good. Dexmedetomidine is not infrequently used. Benzos should never be used.
The current treatment recommendations for the intubated patient from the society of critical care medicine is as follows:
Intubated sedation:
First line — analgesic based sedation (fentanyl) titrated to RASS of 0 or -1 if no other contraindications
Second line — gabaergic agonists - propofol
Substitutions - dexmedetomidine
Maintain MAP > 65
SCCM has excellent guidelines on the biannually updated surviving sepsis recommendations and well as ICU sedation, blood transfusion recommendations (restrictive strategy). One thing is for certain, there is a wide variation of practice styles that should be evaluated in terms of the data. It would be interesting to see which specialities have this issue with propofol. Most anesthesiologists deliver incredibly hemodynamically stable inductions. We have three or four drugs that we can match to the situation or create combinations (ketafol, propofol with phenylephrine) on which we mix the proportions of drugs to achieve effect.
Balanced anesthesia and sedation in the setting of critical illness in my judgment requires and anesthesiologist.
so we’re not supposed to believe that remdesivir was the culprit?....the drug they gave to all the “covid” positive patients once admitted to the hospital..
This article has nothing to do with Covid. It is a pretty biased look at an anesthetic drug by what I assume is a pulmonary intensivist who hasn’t studied induction of anesthesia for airway management. This existed long before Covid and will exist long after. I am daily horrified at the non-anesthesiologists who administer anesthetic drugs with little training and think once size fits all. This also extends to CRNAs who are equally as dangerous despite their well packaged propaganda.
propofol is what that quack doctor gave Michael Jackson in order for him to sleep — MJ died from it.
No crap...ho hum...any sedating drug used during intubation will drop blood pressure and high risk cardiac patients may be at most risk for “complications”.
Michael Jackson, anyone?
Just another breathlessly presented glitzy study that states the obvious that we’ve known about for years concerning sedating drugs including propofol!
Just an ICU nurse....
The guy who was taking care of Michael Jackson was a cardiologist, not an anesthesiologist. It ended badly.
When intubating sick people, you must titrate the drug, take your time, and quickly give pressor (phenylephrine or ephedrine) to counteract the expected transient drop in blood pressure.
Other drugs produce less of a drop.
Either way, the drop is transient and will usually clear pretty quickly. But non-anesthesiologists never attend to this important detail. Then, it can end badly.
I'm amazed that these guys want to do a multi-center study on this problem.
Anesthesiologists hashed this out in short order when propofol was introduced some 40 years ago.
These non-anesthesiologists doing this study need a ticket to clueville. Or better yet, just call an anesthesiologist to intubate sick patients like they do at my hospital.
This CRNA is not “dangerous” and I’m glad my anesthesiologist husband is not a pompous ass
😂
👍🏻
Well with all due respect your society is blurring the lines with the change to the American Association of Nurse Anesthesiology. It is your society who claims you are as trained as anesthesiologists. It is patently untrue. CRNAs are reasonably good physician extenders. But should not be independently practicing the administration of anesthesia.
Sorry you don’t like the facts. But it doesn’t make it untrue. Unless you want to tell me how your training as a nurse anesthetist is equal to that of an anesthesiologist.
That doctor administering propofol was a cardiologist. He knocked of MJ because he has no knowledge of the incredibly small window of sedation with propofol before the onset of GA. It is not a drug for those not trained in how to use it.
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