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Mon Dec 12 19:25:31 GMT 2005

Actually, Propofol can have profound cardio-respiratory effects and cause immediate apnea and hypotension.  Versed and fentanyl can decrease resp rate and sedate of course but, apnea and profound hypotension usually will not occur.  They also are not known to cause any adverse cardiac effects besides a touch of bradycardia.  Propofol can drop your MAP like a rock.   And, they are not also classed as general anesthetics.  So, if the ASA says the drug should be administered by a CRNA or anesthesiologist, I cant disagree.  I dont want the ASA telling me the best way to manage a trauma patient.  Its what they do.  CK
> 
> From: "William Bromberg" <brombwi1 at memorialhealth.com>
> Date: 2005/12/12 Mon PM 01:27:27 EST
> To: <trauma-list at trauma.org>
> Subject: Re: Propofol in Prehospital RSI (Was: ketamine
> 	intrauma-betteroptions!!)
> 
> So instead of propfol which "only crosses that line for a moment" they use versed and fentanyl for the same effect which have a much longer half life and therefore require longer periods of observation, longer periods of airway maintanence, and longer periods of bagging thereby increasing the risk of aspiration due to vomiting. They sure aren't going to be able to get an anesthesiologist to come down for every chest tube or hip/ankle/elbow dislocation.
> 
> The anesthetists/anesthesiologists write a position paper to justfy their jobs but don't want to come to the ED to administer sedation ? even at my hospital when they're in house. I can just imagine what it is like at smaller hospitals with no in-house anesthesia. 
> 
> Of course we could just fall back on "OK anesthesia." You know, "OK, a little pressure now, OK, OK, no, it's all right, OK, just another minute. Somebody hold his hand. Just a second." etc. etc. etc.
> 
> Bill Bromberg
> 
> 
> William J. Bromberg
> Savannah Surgical Group
> 912 350-7412
> 
> >>> Statman2500 at aol.com 12/12/05 10:32AM >>>
>     You may not like their statement, but they are correct.  Unfortunately, 
> some EM docs are using Propofol for moderate sedation procedures (reduction of 
> dislocations, I & Ds).  They point to the GI studies that have been done to 
> justify their dangerous conduct.
> 
>     Let's look at that research:  
> 
>     First, you have "research" by "researchers" who stand to make millions of 
> dollars every year by justifying that they can handle anesthesia on their 
> own.  
> 
>     Second, yes they point to 12,000 patients in their studies.  These are 
> patients who were NPO 8 - 10 hours prior to the procedure (not your typical ER 
> pt.).  They also had ASA scores of I or II.  Rescue intubations were required.
> 
>     Third, the GI groups have requested the FDA to remove the warning 
> statement from the package insert for proppfol that states its use as a general 
> anesthetic and should only be administered by those trained in general anesthesia.  
> This is being done in the name of money, not pt safety.  Of course these are 
> same groups who in a position statement said endoscopy should only be done by 
> a GI doc because of the high risks involved.
>     
>     Fourth, the EM doc is involved with the procedure.  The R.N. is 
> responsible for monitoring the airway.  How many R.N.s are trained to  monitor patients 
> undergoing general anesthesia?  NONE (no we are not including CRNAs).  What 
> happens when the EM doc is pulled away during the procedure to respond to a 
> code and the "sedated" pt. can no longer maintain their own airway?  Is the EM 
> doc going to stand up and say "Maybe I should have reduced the dose?"?  No, he 
> will be screaming it's the R.N.s fault.
> 
>     Fifth, the patient is signing consent for moderate sedation, not deep 
> sedation.  So even though you "only cross that line for a moment", you are 
> crossing it with intent.  So how much is that signed consent worth?  It's 
> priceless.....to the malpractice attorney.
>       
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Propofol in Prehospital RSI (Was: ketamine intrauma-betteroptions!!)