I have an order to titrate propofol to a VAMASS goal of 3A? Most patients on propofol are a MASS 0.
When a patient is heavily sedated (MASS 0) on a propofol infusion, the infusion should be reduced very slowly until the patient is able to obey commands. If you are unable to reduce the rate to achieve a MASS of 3, the order should be changed to reflect the highest MASS score achievable for this patient.
When is it appropriate to administer propofol by bolus?
Propofol should only be administered by continuous infusion when continued sedation is the desired goal. If the patient requires additional sedation, the infusion should be gradually increased. The half-life of propofol is extremely short, and bolus administration only lasts for minutes.
The only indications for the administration of propofol by bolus is for brief sedation during the performance of a procedure, or as a loading dose at the initiation of an infusion.
If propofol is ordered for sedation during a one time procedure only, it can be written in the physician order's sheets. If the sedation is to continue beyond the procedure, the propofol must be ordered using a propofol PrePrinted Order form and ordered as a continuous infusion.
The physician orders a target VAMASS as 3A, but I am unable to achieve it. What should I do?
If despite your best efforts using small incremental changes in medication you are unable to achieve the target VAMASS of 3A, review the target with the physician. Either medication adjustments need to be ordered or the sedation target will need to be adjusted.
