I’m so glad that you pointed out that while the patient is sedated they are not pain free. I see this overlooked constantly in hospitals. ‘Just because our patients can’t complain of pain doesn’t mean they are pain free’
@@Mommyandtux -- For intubated patients, fentanyl is really great, because it seems to disproportionately blunt response to pharyngeal and laryngeal stimulation. Even a little bit of fent can make a big difference as to how well the patient tolerates a tube, and how much sedative they need.
In my opinion propofol is one of the God sent developments in the history of medicine. At least regarding patient comfort. Due to past nightmare procedures I will never submit to any potentially painful procedures or treatments without it.
As I am currently going through ECT I'm becoming extraordinarily familiar with Propofol and I am very thankful that this drug is available for ECT as many of the other sedatives that they might use well let's just say I wouldn't like the side effects. I am truly amazed on the amount of time it does not take to recover from being exposed Propofol. I remember being treated for a gunshot wound back in the eighties and the anesthesia they used on all three surgeries made me sicker than a dog, whereas the propofol that's being used for the ECT treatment that I'm currently under is so much nicer and its recovery time at least in my case is quick and with no illness unlike what happened back in the 80s under the old Style regimen of anesthesia. Anyway thank you for your series I am enjoying it I am not a medical student but I am interested. And again thank you
Don't forget there are consequences to sedation too. As much as we love propofol, we have to make sure we use it appropriately 😉 Glad you are liking the videos!
@@eduardodiaz9354 That is certainly a risk to weigh in the decision for sedation. Restraints are also another option to help mitigate this, while keeping sedation levels lower. I'm certainly no advocate for no sedation, but it also needs to be used appropriately and at the right level.
@@ICUAdvantage unfortunately at my hospital they don’t use restraints 😞. I’ve been listening to a podcast you should look it up “Walking home from the ICU” there is a facebook page too go look at some of their videos
Loved the video. I'm am ER nurse. My ER rarely uses Propofol except for procedural sedation as a one time dose. Nobody really talks about how to use propofol because we usually use fentanyl and versed. Thanks for the tips!
our er uses it for intubation after etomidate and rocuronium for post intubation sedation but not for procedural sedation mostly etomidate and ketamine
Awesome video! I'm orienting in the ICU and honestly I need to keep educating myself about the nursing considerations for each drip. This helped a lot. Is it possible to do a video on Precedex? My ICU uses that one a lot for the sake of SBTs.
Hi I think it's action is through Hyperpolarisation of Chloride channels (GABA acts via Chloride receptors). Not Calcium channels, but great summary of the drug though.😅
You forgot one indication of this medication, General anaesthesia for prolonged invasive oral procedures in the dental office setting. Can be afministered chairside prior to nasal intubation for dental work
Thanks for the video. One bit I'm not quite clear on, you said that GABAA potentiates calcium influx. Did you mean to say chloride influx? Potentiating chloride influx has the inhibitory effect (being negatively charged), whereas calcium should have the opposite effect. Inhibition of calcium influx in neurons is a MOA for opioids to reduce pain transmission in the spinal cord. At least that's how I've understood it, unless your reference says something different? Thanks in advance.
Any USA propofol clinical trials for treatment resistant depression w psychotic features yet? I have abnormal epileptiform eegs for decades now without actual seizures. Propofol after effects for a colonoscopy i had was an absolute mood miracle for me, however short lived.
Would you be able to explain why a patient in ICU with multiple grand mal seizures would be on both propofol and Versed at the same time? Why can't the patient be on just propofol without Versed? Thank you.
Hi Eddie. I am watching your videos to prep for CRNA school interviews. I noticed on this propofol video that you state that it helps to slow closing of calcium channels on GABA receptors. I have read on multiple sources that propofol works by prolonging the opening of chloride channels to hyperpolarize the cell. Could you clarify this for me please?
i m confused about calcium channel in this level, i think its acting as hyperpolarizing by opening the chlore channel(not the ca+) and that's how it hyperpolarize the membrane and prevent action potential!!
Hai Edie I’m deshani again from srilanka and I’m cardio thoracic icu nurse 👩⚕️ and this vedio updated my knowledge again and again .thank you .aren’t you interested about PiCCO technology ? Can u give us a vedio about PiCCO? Then 👋
Tell me does this hit the gaba a receptors. If I've just come off benzodiazepines what are the alternatives for general anesthetic. I'm somewhat concerned..can fentanyl only be used for general anesthetic. As can't have anything that acts on gaba a receptors. As downregulated by benzodiazepines.
Important question for the author, please help me put my mind at ease as I suffer from severe health and cardiovascular related anxiety. I am scheduled for a procedure in about 20 days, and I am worried. When I wake up in the mornings, it's extremely common for my heart rate to be in the high 40s, so technically already in Bradycardia, and my BP has been 98/69. When I get out of bed and moving these things go up to what one would consider average. Heart rate hangs around upper 60s, and BP is 120/75 approximately. As my heart rate is often this low during sleep or rest, am I at increased risk of an even lower heart rate and does propofol pose more risk to someone like me who has a low heart rate at rest? Also if relevant I have a completely normal heart,, two EKG's in the last 6 months showed not even so much as a sinus arrythmia. I got a good bill of health as far as heart health. So anyway, am I in danger of higher chance of mortality or danger of any sort?
Gotta wonder how much is actually "remembered." I suppose the right jumping off point is asking anesthesiologist what they have seen in sedated people?
Are there any contraindications using propofol with patients with high potassium like crush injuries? I recently learned that GABA be receptors act on moving potassium to create hyperpolarity.
Great question and it kind of depends on the rate they are at. If its pretty low, 5-15, you might be able to just pause it, let them wake up, get the assessment and put it back on at the rate you were at. For higher rates, sometimes you don't even need to fully turn it off. If you can get the assessment you need without going completely off, thats great. Sometimes, especially with more significant deficits and injury, you need to be sure you are scoring as low as you are getting and that would require fully turning it off. At higher doses, you may need to quickly wean it down to off. Usually not a good idea to just turn it off as they can wake suddenly and it can cause more agitation and issues.
I’m so glad that you pointed out that while the patient is sedated they are not pain free. I see this overlooked constantly in hospitals. ‘Just because our patients can’t complain of pain doesn’t mean they are pain free’
100%
I've seen it far to often and a really important thing to understand!
@@ICUAdvantage
Isn't it relatively common practice to push fentanyl or hydromorphone or morphine together with the Propofol?
But you can easily perform TIVA using only propofol for electrical cardioversion
100% accurate. I've had 4 cardioversions since March 2020, and out of those 4, propofol was used twice (the other 2 were done using ketamine).
@@Mommyandtux -- For intubated patients, fentanyl is really great, because it seems to disproportionately blunt response to pharyngeal and laryngeal stimulation. Even a little bit of fent can make a big difference as to how well the patient tolerates a tube, and how much sedative they need.
So much better than a textbook. Thank you!
Great to hear this Megan. Glad you liked it.
I am pediatricintensivist from India.appreciate your presentations
In my opinion propofol is one of the God sent developments in the history of medicine. At least regarding patient comfort. Due to past nightmare procedures I will never submit to any potentially painful procedures or treatments without it.
Had never heard of Propofol Infusion Syndrome, learned something new today. Great vid!
I have weekly ECT treatments and have been curious about how the anesthetic works. Thank you!
As I am currently going through ECT I'm becoming extraordinarily familiar with Propofol and I am very thankful that this drug is available for ECT as many of the other sedatives that they might use well let's just say I wouldn't like the side effects. I am truly amazed on the amount of time it does not take to recover from being exposed Propofol. I remember being treated for a gunshot wound back in the eighties and the anesthesia they used on all three surgeries made me sicker than a dog, whereas the propofol that's being used for the ECT treatment that I'm currently under is so much nicer and its recovery time at least in my case is quick and with no illness unlike what happened back in the 80s under the old Style regimen of anesthesia. Anyway thank you for your series I am enjoying it I am not a medical student but I am interested. And again thank you
Whenever I am sedated to have a surgery I have Propofol. I love it, the feeling I get from it just before I fall asleep.
Thanks for this video. 🙏
Weird.
So helpful for newly joined icu nurses...all of ur videos are so helpfull for me....ty❤️
Best Videos on RUclips all the time. Thank you so much
Awesome!!!
When in doubt knock em' out. I have been redeployed to the ICU and your videos are helping me so much!
Don't forget there are consequences to sedation too. As much as we love propofol, we have to make sure we use it appropriately 😉 Glad you are liking the videos!
@@ICUAdvantage what about the risks of patient extubating themselves?
@@eduardodiaz9354 That is certainly a risk to weigh in the decision for sedation. Restraints are also another option to help mitigate this, while keeping sedation levels lower.
I'm certainly no advocate for no sedation, but it also needs to be used appropriately and at the right level.
@@ICUAdvantage unfortunately at my hospital they don’t use restraints 😞. I’ve been listening to a podcast you should look it up “Walking home from the ICU” there is a facebook page too go look at some of their videos
Thank you so much so much. Critical Care Paramedic here!
You're so welcome! Definitely a lot of good info here for you guys!
Loved the video. I'm am ER nurse. My ER rarely uses Propofol except for procedural sedation as a one time dose. Nobody really talks about how to use propofol because we usually use fentanyl and versed. Thanks for the tips!
Its interesting how different providers do things differently. I much prefer Prop for a lot of reasons, but unfortunately not always possible to use.
our er uses it for intubation after etomidate and rocuronium for post intubation sedation but not for procedural sedation mostly etomidate and ketamine
Wow 1,000+ likes to 6 dislikes.
That's one of the highest like:dislike ratios on RUclips.
I gave you another like and a sub, keep up the good work.
Awesome man! Much appreciated! I will certainly do my best to keep them coming.
I just got done with my first internship in a hospital pharmacy and the bottles of propofol looked so tasty!
ER RN we use this a lot and wow :) thank you for the lesson
excelent information thanks. i am new at anestesiology very usefull video thanks Doctor. my best from México
thank you! ive been doing a marathon of lessons from your channel, it helps a lot!
Awesome! That could be a LONG marathon! lol
Awesome video! I'm orienting in the ICU and honestly I need to keep educating myself about the nursing considerations for each drip. This helped a lot. Is it possible to do a video on Precedex? My ICU uses that one a lot for the sake of SBTs.
Glad you find them helpful. And yeah I do have Precedex on the todo list!
Very well done 👍🏻
All your videos and so helpful and give me helpful information!
These are absolutely amazing
I'm definitely going to be watching these and writing stuff down. Keep up the incredible work
Awesome! Glad you liked it!
Thank you thank you thank you. I love your channel, you're such a great educator
I appreciate the kind words!
Can you do a video on insulin drips? Thanks for the videos! They help a lot!
I do have it on the todo list! 😊
@@ICUAdvantage please! Insulin is terrifying because it can be so dangerous! Thank you 💚
Hi I think it's action is through Hyperpolarisation of Chloride channels (GABA acts via Chloride receptors). Not Calcium channels, but great summary of the drug though.😅
Ahhh yes I went back and looked and you are 100% correct. Chloride influx creates the negative potential and stops the AP! Thanks for the catch!
Thanks ! Physiology classes decades ago.
You forgot one indication of this medication, General anaesthesia for prolonged invasive oral procedures in the dental office setting. Can be afministered chairside prior to nasal intubation for dental work
If you haven’t done one yet, could you do one on ketamine!?! Your videos help a ton as a new ICU nurse!
Thank you! happy to hear they are helpful for you. I have not done Ketamine yet, but it is on the todo list!
I’ve not seen this med used for status epilepticus. Thank you for pointing that out!
I have tle, and i never heard it being used for epilepticus either. It's always been midazolam bc it is way stronger. Dosed 20x lower than this drug
Thanks for the video. One bit I'm not quite clear on, you said that GABAA potentiates calcium influx. Did you mean to say chloride influx? Potentiating chloride influx has the inhibitory effect (being negatively charged), whereas calcium should have the opposite effect. Inhibition of calcium influx in neurons is a MOA for opioids to reduce pain transmission in the spinal cord. At least that's how I've understood it, unless your reference says something different? Thanks in advance.
Thank you. Brief yet with enough details.
I love it!!!💕 I get it for spine injections at Pain Management.
It sounds similar to the mechanism of the barbiturates from what i've read. Although i know it isn't related.
A very great video,, thanks so much,, plz continue these useful videos,, I am always waiting 4 them
Thank you so much! I will definitely keep making them!
Any USA propofol clinical trials for treatment resistant depression w psychotic features yet? I have abnormal epileptiform eegs for decades now without actual seizures. Propofol after effects for a colonoscopy i had was an absolute mood miracle for me, however short lived.
Thank you so much Eddie, love your channel !
Happy to help Winnie! 😊
very good work
great lesson! thank you for sharing the information.
Absolutely my pleasure! 😊
Hi ICU Advantage,
May you consider doing a video on buprenorphine
That Propofol is good stuff, best sleep ever.
Thanks for this awesome 👌 video
I have quick question
Sometimes they used combination of propofol + ketamine. What do think about that ?!
Make a video on stages of anesthesia specially depth of anesthesia
Can you do a talk on propofol and TCI
Would you be able to explain why a patient in ICU with multiple grand mal seizures would be on both propofol and Versed at the same time? Why can't the patient be on just propofol without Versed? Thank you.
Hi Eddie. I am watching your videos to prep for CRNA school interviews. I noticed on this propofol video that you state that it helps to slow closing of calcium channels on GABA receptors. I have read on multiple sources that propofol works by prolonging the opening of chloride channels to hyperpolarize the cell. Could you clarify this for me please?
Greetings from Brazil! Nice work!
Awesome! Hello in Brazi! Thank you!
Thanks for the videos. Amazing explanation!!!
My pleasure! Glad you enjoy them. Thank you!
Thanks bro 👍👍👍👍
Absolutely my pleasure!
yes great video ! regards liz from uk 🇬🇧
Awesome! Thank you Liz! 😊
i m confused about calcium channel in this level, i think its acting as hyperpolarizing by opening the chlore channel(not the ca+) and that's how it hyperpolarize the membrane and prevent action potential!!
Thank you for this content!
You are very welcome!
Great video Eddie
Appreciate you Justin! Happy to hear you liked it!
Great informative lecture
Glad it was helpful!
Thank you..🙂👍🏾
You're welcome! 😊
What are some Red flags with use? Signs that you need to titrate the drug?
thanks for the video :)
❤ than you!
Thanks
You are welcome as always! 😊
Great info! Thank you
Glad to hear this! You are very welcome Shawn!
Good content
thank you so much! loved this lesson. do you think.you can cover also dexmedethomidine?
Yes! It's on the todo list!
Thank you🙂
You're welcome 😊
@@ICUAdvantage Your lesson are so informative. Thanks for updating 🙂
amazing video thank you
Hai Edie I’m deshani again from srilanka and I’m cardio thoracic icu nurse 👩⚕️ and this vedio updated my knowledge again and again .thank you .aren’t you interested about PiCCO technology ? Can u give us a vedio about PiCCO? Then 👋
I personally haven't seen/used it, but I've had a few requests on it, so I'll have to consider covering it in the future.
Tell me does this hit the gaba a receptors. If I've just come off benzodiazepines what are the alternatives for general anesthetic. I'm somewhat concerned..can fentanyl only be used for general anesthetic. As can't have anything that acts on gaba a receptors. As downregulated by benzodiazepines.
Thanks for this video!
You're very welcome!
Propofol-related infusion syndrome ( PRIS) always reminds me of Michael Jackson
Hi there, how about the usage of propofol in ventricular tachycardia?
How do I obtain this for personal use
Thanks!
Wonderful work
Go on
Thanks
Thank you so much!
Nice......
Thank you!
While changing the tubing, do you need to also change the cannula too
Nope!
Good and useful
Glad you think so!
Very helpful
Glad to hear it!
Is watching this channel good prep for CCRN?
I’d like to think so. I’ve got a lot of good videos that I think would be helpful
Important question for the author, please help me put my mind at ease as I suffer from severe health and cardiovascular related anxiety. I am scheduled for a procedure in about 20 days, and I am worried. When I wake up in the mornings, it's extremely common for my heart rate to be in the high 40s, so technically already in Bradycardia, and my BP has been 98/69. When I get out of bed and moving these things go up to what one would consider average. Heart rate hangs around upper 60s, and BP is 120/75 approximately. As my heart rate is often this low during sleep or rest, am I at increased risk of an even lower heart rate and does propofol pose more risk to someone like me who has a low heart rate at rest? Also if relevant I have a completely normal heart,, two EKG's in the last 6 months showed not even so much as a sinus arrythmia. I got a good bill of health as far as heart health. So anyway, am I in danger of higher chance of mortality or danger of any sort?
What qaunitiy propofol add for solusions ? what type solution correct use mixed with propofol?what dose can used for 24 h safely?
Great video as always!
What dosage would you recommend for gastroscopy and colonoscopy?
Thank you Rade. The procedural sedation dosing mentioned.
That's there a nyc piece of info.. 🥰
Yay!!! 😊
Does propofol decrease the body temperature?
facing difficulty to calculate infusion . ml per hour
Gotta wonder how much is actually "remembered." I suppose the right jumping off point is asking anesthesiologist what they have seen in sedated people?
Are there any contraindications using propofol with patients with high potassium like crush injuries? I recently learned that GABA be receptors act on moving potassium to create hyperpolarity.
great content!
Glad you like it Matt!
Hi sir..am a CCT student...
Awesome!
can i use propofol instead of melatonine pill for sleeping i want to sleep immidiately
no
great
Great informative video! It is also excreted through exhalation
love the milk of anaesthesia
It is a great drug!
You’re awesome
When doing hourly neuro checks on a patient on prop....would one just turn off every hour or would one wean prior?
Great question and it kind of depends on the rate they are at. If its pretty low, 5-15, you might be able to just pause it, let them wake up, get the assessment and put it back on at the rate you were at.
For higher rates, sometimes you don't even need to fully turn it off. If you can get the assessment you need without going completely off, thats great. Sometimes, especially with more significant deficits and injury, you need to be sure you are scoring as low as you are getting and that would require fully turning it off. At higher doses, you may need to quickly wean it down to off. Usually not a good idea to just turn it off as they can wake suddenly and it can cause more agitation and issues.
Nice
Thanks
Can propofol be used repeatedly for short procedures
Yup. An effective push dose can be given, and if the procedure is not over and they are beginning to waken, more can be given.
Tq😁
I am sorry, but i thought that dosage for continuous infusion is measured in mcg/kg/HOUR, not MINUTE
There are dosing ranges that I've seen in mg/kg/hr, but for the doses that I was referring to they are mcg/kg/min
PLEASE MAKE A VIDEO ON NON INVASIVE VENTILATION
I do have it already. Look for the blue background in the videos and CPAP vs BiPAP
Another great video 👍🏽👍🏽. Thanks for putting in the work.
Thank you so much! Truly my pleasure!
❤👍
Overdose of this shit killed mj .
Why is the using of Propofol permitted when its not understand how exactly it works? Wtf?
MJ favorite drug
was*