How about a "POP" quiz!

[Jonathan]

Starting with an easy question...

Is Propofol a safe anesthetic? What are its side effects? How can we
minimize them? Is there any safe anesthetic?

[vivian sweet]

propofol causes apnea like most drugs will have a side effect is it safe I would say no because you need to be cautious with any type of induction drug and how much you give and how give it slow.

> Date: Tue, 10 May 2011 01:59:01 -0700
> Subject: How about a "POP" quiz!
> From: jonatha...@gmail.com
> To: AVECCT...@googlegroups.com

[Patricia Zehna]

Agree, apnea is the main negative side effect, which can be minimized by pre-oxygenation. It can be better balanced by being administered with a benzo such as diazepam or midazolam- always titrate to effect, checking jaw tone, give minimum amount needed to allow safe intubation. "There is NO safe anesthetic only safe anesthetists"

Patty

 

Patricia R Zehna, RVT
ICU Technician
Monterey Peninsula Veterinary Emergency & Specialty Center
(831) 373-7374
Treasurer IVAPM
International Veterinary Academy of Pain Management
Board Moderator VSPN
Veterinary Support Personnel Network
Wildlife Rehabilitation Volunteer
SPCA for Monterey County
pze...@gmail.com

[Jonathan]

Yep Patty...thats the quote I was looking for. Anyone else have any
thoughts on Propofol?

On May 10, 12:12 pm, "Patricia Zehna" <pze...@gmail.com> wrote:
> Agree, apnea is the main negative side effect, which can be minimized by pre-oxygenation. It can be better balanced by being administered with a benzo such as diazepam or midazolam- always titrate to effect, checking jaw tone, give minimum amount needed to allow safe intubation. "There is NO safe anesthetic only safe anesthetists"
> Patty
>
> Patricia R Zehna, RVT
> ICU Technician
> Monterey Peninsula Veterinary Emergency & Specialty Center
> (831) 373-7374
> Treasurer IVAPM
> International Veterinary Academy of Pain Management
> Board Moderator VSPN
> Veterinary Support Personnel Network
> Wildlife Rehabilitation Volunteer
> SPCA for Monterey County
> pze...@gmail.com
>
>
>
>   ----- Original Message -----
>   From: vivian sweet
>   To: avecct...@googlegroups.com
>   Sent: Tuesday, May 10, 2011 9:23 AM
>   Subject: RE: How about a "POP" quiz!
>
>   propofol causes apnea like most drugs will have a side effect is it safe I would say no because you need to be cautious with any type of induction drug and how much you give and how give it slow.
>
>   > Date: Tue, 10 May 2011 01:59:01 -0700
>   > Subject: How about a "POP" quiz!

>   > From: jonathan.esm...@gmail.com

[Liz Hughston]

The only other thing I would say is to be careful not to extravasate the drug: it can cause tissue sloughing.  Also, be careful how long you leave it out after the seal has been broken.  I think it's only good for 24 hours(?)

[Patricia Zehna]

Actually it should be discarded after 6 hours, although there is a new Propofol 28 that is good for 28 days! We just started using it in our hospital. It's only for use in the canine because the preservative is thought to be toxic to cats.

I haven't ever heard of tissue sloughing with Propofol although I think all anesthesia's should have IV catheters in place.

[vivian sweet]

I thought the drug was only good for 6hrs after opened

[Liz Hughston]

Huh.  I'll check the product insert when I get to work.  Could be the old clinic I worked at stretched the rules a bit.  At my current hospital, we use so much diprivan it's never around for more than an hour or two :)

Liz

[Liz Hughston]

Hi all,

Product insert for Propofol/DIPRIVAN states that it is safe from microbial contamination for up to 12 hours.  Any Propofol/DIPRIVAN still in use when the procedure/anesthesia/sedation hits the 12-hour mark should be discarded and any IV lines should be flushed completely or changed.

The insert also reminded me that anaphylaxis is another complication to beware of.  Additionally, there is Propofol Infusion Syndrome, "characterized by severe metabolic acidosis, hyperkalemia, lipemia, rhabdomyolysis, hepatomegaly, cardiac and renal failure."

HTH,

Liz Hughston, BA, MEd., RVT

Adobe Animal Hospital

[Patricia Zehna]

You are correct but Propoflo (by Abbott) and Rapinovet (by Schering) are only good for 6 hours- perhaps they use a different preservative? In any case these are the ones I have used almost exclusively in vet med.

Patty

 

Patricia R Zehna, RVT
ICU Technician
Monterey Peninsula Veterinary Emergency & Specialty Center
(831) 373-7374
Treasurer IVAPM
International Veterinary Academy of Pain Management
Board Moderator VSPN
Veterinary Support Personnel Network
Wildlife Rehabilitation Volunteer
SPCA for Monterey County
pze...@gmail.com

----- Original Message -----

From: Liz Hughston

To: avecct...@googlegroups.com

[Jonathan]

Other than apnea I am thinking about the marked vasodilation second
only to inhalants....

>   On Wed, May 11, 2011 at 12:21 PM, Liz Hughston <mackhughs...@gmail.com> wrote:
>
>     Huh.  I'll check the product insert when I get to work.  Could be the old clinic I worked at stretched the rules a bit.  At my current hospital, we use so much diprivan it's never around for more than an hour or two :)
>
>     Liz
>

>     On Wed, May 11, 2011 at 9:45 AM, vivian sweet <vivo...@hotmail.com> wrote:
>
>       I thought the drug was only good for 6hrs after opened
>

>       Liz Hughston <mackhughs...@gmail.com> wrote:
>
>       >The only other thing I would say is to be careful not to extravasate the
>       >drug: it can cause tissue sloughing.  Also, be careful how long you leave it
>       >out after the seal has been broken.  I think it's only good for 24 hours(?)
>

[Jonathan]

Anyone have a good question to share?

[Patricia Zehna]

Ahh, of course!

Clearly contraindicated in times of shock, hypotension, pre-existing vasodilation, negative inotropy, dehydration, perhaps pre-existing cardiac arrhythmia, etc. That being said some patients may still be stable enough for it's use. 

One of the reasons why combining the drug with opioids, benzodiazepines, and perhaps lidocaine to reduce the volume of propofol used is a good idea, although there may be safer options depending upon the case.  

Hmm, let me think of a question....

[Kelly Cronin]

It also causes heinz body anemia with serial use in cats.  (i.e. those continuous seizure cats we put on CRI and serial radiations) 

There are some newer studies showing microbial safety out several days. ( the anesthesia boot camp in CO brought them to our attention) Which is why VESCNM ( Where Viv and I work) has moved out to 5 day use. 

Also, it can cause fat emboli if given IV after refrigeration. So no propofol in the fridge per the manufacturer.     

--
Kelly Lynn Cronin, R.V.T., L.V.T., B.S. Animal Science
Lead Technician
Veterinary Emergency & Specialty Center of Santa Fe

2001 Vivigen Way

Santa Fe, NM 87505

505-984-0625

kel...@yahoo.com
cell:505-913-0877

[Kelly Cronin]

OK another question for everyone ....

In a diabetic cat we check urine for two main conditions, what are they and what is the course of treatment for each. 

Follow up, in a newly diagnosed diabetic cat with a high blood glucose do we initiate an insulin protocol immediately?  Why or why not?

[amy flint]

ok, i'll give this a shot

Diabetic patients, checking for glucouria and ketonuria. Treatment is to initiate regular insulin treatment, checking BG hourly to adjust insulin dose and glucose supplementation to maintain BG 8-12mmol/l (sorry I haven't figured out the USA conversion yet)

---

Date: Fri, 13 May 2011 19:12:04 -0600

Subject: Re: How about a "POP" quiz!

From: kelly.ly...@gmail.com
To: avecct...@googlegroups.com

[Kelly Cronin]

Great! the one change per our internal medicine specialist and the last DKA lecture at IVECCS is to initiate insulin after initial rehydration.  4-6 hours after fluids are started to correct for dehydration concentration on glucose in the blood before treating.