Deep Sedation - Dr. Musey

* Propofol is used in >95% of residency training programs - well established to be safe & effective*

> Propofol - Fast onset (2-5 min) fast recovery (5-10 min)

   - Great for short painful procedures - fracure DL, I&D, etc

   - Possible ADR - hypoventilation, partial obstruction, apnea, hypotension, bradycardia

  - No analgesia - however most patients do not recall or report pain; if you give additional opiods -

    taper propofol dose


> Get equipped!  {These are specific for CMC at current date}

  1. Oral & nasal airways, O2, ambu bag with mask, direct or video laryngoscopes, ET tubes,
      suction, ECG monitoring with pulse ox, End tidal CO2 , code cart, narcan and flumazenil

  2. For ASA class 1 & 2, Mallampati class <3 - consult anesthesia if outside these guidelines or
      pregnant

  3. NPO for 2 hrs from clear liquids, 6 hrs nonclear liquds & food; deviation MUST be justified by
     attending physician

  4. Need 2 physicians - attending needs to push meds

  5. QA review - things that must be documented - apnea > 15 sec, ETT PPV, O2 dsat < 90% for >
      90 sec, vomiting, unexpected change in vital signs, use of reversal agent, emergent anesthesia
      consultation, NPO guideline deviation

  6. Nurses CANNOT push; only attending can push or a resident under direct supervision of
       attending not also doing the procedure (required 3 docs at bedside)

  7. Doses - 0.25 - 1 mg/kg bolus (adults and peds) then q3-5 min can give 0.2-0.5 mg/kg;
                    - Draw up 1 mg/kg & infuse slowly over 3-5 min

  8. Consider lidocaine or fentanyl predosing to help ease pain at injection site (fentanyl 1mcg/kg IV
      in same line you're giving propofol)

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