Know your Poison No. 4 (Paperback)

Toximonic of “Falls on All IV = 4” for Easy RecallProp-O-fol = pronounced as “Prop ‘O’ Fall” •Prop means to keep from falling or slipping by providing a support under or against•Fall is a 4-letter word, so propofol causes rapid fall in all vitals•“IV” means 4 as roman number•IV stands for Intra Venous, as propofol is injected as intravenous anesthetic. Prop-O-fol = causes Prop ‘O’ Fall: Toximonic of IV- Falls for Easy Recall:- 1)Fall in GCS (coma inducer)- thus the victim is knocked down, can’t stand on all 4 limbs2)Fall in Intracranial pressure (ICP): helpful in Head injury & acute Brain Stroke3)Fall in Memory: Propofol is known as milk of amnesia by anesthetics 4)Fall in seizure rates recurrence during status epilepticus Overdose of IV- Propofol causes iatrogenic complications:•Fall in Breath rate (bradypnea) can cause apnea & decreased response to PaCO2 & PaO2 -> have to provide controlled ventilation if using boluses.•Fall in Blood Pressure (causes vasodilation and negative inotropy -> hypotension)•Fall in renal function: decrease renal blood flow and GFR from hypotension•Fall in muscle power by Rhabdomyolysis due to uncoupling of oxidative phosphorylation in mitochondrial ETC (electronic transport chain)•Fall in Pulse rate of Heart (bradyarrhythmia)•Fall in pancreatic function due to excess load of fatty acids in propofol infusion on prolonged use, causing pancreatitis Fall is a IV- 4-letter word: All 4’s for easy recall: - 4- major indications of propofol use in allopathy:1)Induction + maintenance of General Anaesthesia2)Procedural Sedation for bronchoscopy, Upper gastrointestinal endoscopy, colonoscopy, sigmoidoscopy (Procedure done in posing on All 4’s) 3)Status Epilepticus & Eclampsia, may provide some cerebral protection4)Status Asthmaticus: bronchodilator properties may be useful in treating bronchospasmsIV- 4- Nursing tips: Do’s & Don’ts for propofol injection:•SHAKE WELL BEFORE USE•infuse undiluted; if there is a need to dilute prior to administration, use only dextrose 5%. •Do not dilute to a concentration <2mg/mL•Do not use if evidence of separation of the emulsion•must change IV tubing and bottles q12h when running as a continuous infusion•maintain strict aseptic technique during handling as vehicle can support rapid bacterial growthIV- 4- Emergency tips: Do’s & Don’ts for propofol usage: All 4’s & P’s for easy recall•P-Prefer 4 hour NPO (Nil Per Mouth) before P-Procedural sedation•P-Pressure over cricoid during rapid sequence intubation to P-Prevent aspiration •P-Proton Pump Inhibitors – P-Pantoprazole is helpful as Prophylaxis for acid refluxIV- 4- major uses of propofol for non- therapeutic purposes (off-label use):1)Recreational misuse among Operation theatre related anesthetics, staff & paramedics2)Legal execution for causing sudden death during capital punishment in west3)Drug abuse for refractory insomnia (As the case of Michael Jackson Popstar’s death)4)Veterinary use for chemically restraining the violent mad wild animals: elephants IV- 4- unique facts of propofol:•Its not listed as narcotic, not covered under Narcotic Drugs & Psychotropic Substances Act •It can be given by Registered Nurses in absence of doctors, to intubated, ventilated patients•Unwillingness of insurers to reimburse anesthesia care for some procedures such as diagnostic endoscopy has increased the use of nurse-administered propofol.•Its Continuous infusion is not recommended for use in children < 18 years of age.All IV- 4’s for easy recall for doses of Propofol: -•Propofol induction Bolus –2mg/kg (half of four) approx.. 40mg q10sec•Onset of action: within 40 seconds of IV injection•Maintenance dose of propofol infusion: 4 – 12mcg/kg/min•Children: induction dose: