My husband’s in ICU in an induced coma on Midazolam, he’s not waking up, should he have Propofol?

https://intensivecarehotline.com/questions/my-husbands-in-icu-in-an-induced-coma-on-midazolam-hes-not-waking-up-should-he-have-propofol/

My husband is in ICU in an induced coma on Midazolam(Versed), he’s not waking up, should he have Propofol instead? Live stream!

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Welcome to another Intensive Care Hotline and Intensive Care at Home livestream. Good evening to our viewers in the United States and North America. Good morning to our viewers in Australia and New Zealand. I don’t know whether we’ll have anyone here from the U.K. today or from Ireland. It’s in the middle of the night there. Nevertheless, welcome to today’s livestream.

Today’s livestream is about, “My husband’s in intensive care in an induced coma on midazolam. He’s not waking up. Should he have propofol instead?” That’s what I want to focus on today, on different sedatives in ICU. Obviously, this is a question that we get quite frequently if people have done a little bit of research. I mean, many families in intensive care are oblivious to the things that are happening. They are oblivious to the questions they should be asking. Obviously, this reader has done some research in order to even get to that question. It’s a very intelligent question to ask and it’s a question that many clinicians in ICU ask as well.

Now, before I go into today’s topic, just a few housekeeping issues. Please type your questions into the chat pad. Keep them to today’s topic, if you can. If they are not on today’s topic, please type them in anyway and I’ll get to them towards the end of the presentation.

Before I go into today’s topic, I just want to make a quick introduction about myself. You might wonder what makes me qualified to talk about this topic. I have worked in intensive care for over 20 years in three different countries. Out of those more than 20 years, I have worked as a nurse unit manager in intensive care for over five years. I have also been an in-charge nurse on shifts. I have been consulting and advocating for families in intensive care all around the world since 2013 as part of my intensivecarehotline.com blog. I also own and operate a service, Intensive Care at Home, where we look after predominantly long-term ventilated intensive care patients, where we bring the intensive care into the home. That’s a little bit about me.

Let’s dive into today’s topic. Reader writes, “My husband’s in intensive care in an induced coma on midazolam. He’s not waking up, should he have propofol?” Especially for our viewers in North America, midazolam is also known as Versed. You might have heard of Versed instead of midazolam. The terms are interchangeable. It’s just one is the generic name, one is the brand name. At the end of the day, it’s the same medication that we are referring to.

Now, let’s just set the scene here. When someone is in intensive care on a ventilator with a breathing tube or an endotracheal tube, they are going into an induced coma. First-line sedative is often propofol and which goes hand-in-hand with fentanyl or morphine. Those are standard sedatives and opiates in intensive care for an induced coma. Also, when patients come back from surgery to intensive care, they’re often sedated with propofol and fentanyl or morphine. Fentanyl or morphine, obviously the pain medicine also known as opiates.

Then, if someone stays in an induced coma for a few days and the propofol has undesired side effects such as hypotension, which means low blood pressure, if someone is not responding favorably to propofol, which means they might be having high doses depending on their weight. For someone with 60 or 70 kilos, you might be okay with 100 milligrams an hour of propofol. For someone with 100 kilos, you might be needing 200 milligrams an hour of propofol in order to sedate them.

Continue reading at: https://intensivecarehotline.com/questions/my-husbands-in-icu-in-an-induced-coma-on-midazolam-hes-not-waking-up-should-he-have-propofol/