Shiv Rattan Kochar

Know your Poison No. 4 Shiv Rattan Kochar

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