![]() ![]() ![]() It is useful in patients in withdrawal or those difficult to ventilate. Versed gtt will help with agitation and withdrawal. It is cruel, in my opinion to have a patient on propofol only. if the patient is in pain they will remain in it. Also have the residents order lacrilube for their eyes and apply Q4h, you do not want their eyes drying up.įentanyl gtt is for pain and has sedative effects ![]() ![]() This is why pushing nimbex if someone isn't sedated is well, wrong. Paralytic therapy is great when a patient is in ARDS and is requiring high levels of PEEP or an inverse I:E ratio that is unnatural to oxygenate the lungs, but remember you are paralyzing someone, if they are not adequately sedated then it is not only frightening but torturous. If your facility uses a BIS monitor you want to have a BIS score of 40-50, also when doing TOF you want 1-2 twitches out of 4. bolus with versed and fentanyl, increase your propofol drip and then begin the nimbex infusion. Works well on patients who are withdrawing from etoh but don't quite need versed.Īnd now let's talk about nimbex (1-10mcg), nimbex is a paralytic, it is very important that your patient be adequately sedated before beginning a nimbex gtt. I have seen people drop their HR to the 40-50 range on this gtt. It does not affect respiratory centers of the brain but can cause bradycardia and should be stopped. Precedex (usually max dose is 1.5 mcg/kg/min facility dependent) the hit or miss of sedative drugs, Neuro loves it, mainly because it does not sedate but calm. I usually see versed/fentanyl/propofol on a patient who is chemically paralyzed. Some physicians order it alongside fentanyl/propofol depending on how much sedation they need. Versed at high doses also works almost like a hypnotic. Versed (max dose 10mg/hr) is a benzo and works well on patient who are withdrawing from ETOH and intubated. It is great when used for short term sedation. At high doses propofol can cause propofol infusion syndrome, discoloration of the urine, and high triglycerides. Propofol (max 50mcg/kg/min) is a powerful sedative with a short half life, most patients wake up within 30 minutes of turning the gtt off/down. It is important to keep in mind that by its self fentanyl is not a sedative and should not be used as such. So again, my question is, why Propofol instead of Versed? I mean, it definitely worked after some titration, but I'm trying to understand why she was on Versed in the first place, and why Propofol was better for her?įentanyl (usual dosage 10-200mcg/hr) is an opiod medication often used as a gtt in critical care not only for its pain relieving properties, but its synergistic effects when combined with propofol and/or precedex. When I made the doctor aware, she said to switch her over to a Propofol gtt and off the Versed gtt if she could tolerate it. I gave 2mg IVP Versed x2, in addition to increasing her Versed gtt up, and then finally a dose of PRN Nimbex which appeared to work for like only 15 minutes. Her respiratory rate was set at 28, however her breathing rate was between 30-50, and she was coughing over the vent it seemed. One case that confused me was a patient I had admitted with ARDS who was mechanically ventilated and on Versed gtt and Fentanyl gtt. So I was wondering what's the indication for each.Įxamples of Different Combinations of Sedation I've had: I'm new to critical care and what's confusing me is the different gtts used for sedation, mostly because all my patients are never on the same thing. ![]()
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