I have been purchasing Propofol for clinic sedation from B.Braun for years. As an Anaesthetist with Day Surgery as my subspecialty, this is undoubtedly my drug of choice for clinic cases requiring deeper levels of sedation. I've used it twice in Simply Aesthetic. Once a year ago for an APTOS demonstration and earlier this week, just to tide my patient through liposuction of the sensitive inner thigh area.
Used properly, this drug is sweet. Fast acting, short duration, rapid recovery. Misused, this turns into a beast that stops breathing, crashes the blood pressure, and can be very frightening.
I was in two minds to even bring my residual stock to the clinic, but I'm glad I did. The patient I had to use it on is even more relieved! And my hesitancy? Knowing how quickly it works and how dangerous it is when used without specific monitoring and airway support, I did not want to add risk to a procedure when I was scrubbed and unable to manage the airway if needed. We manage just fine with simpler forms of sedation during WAL. But if it is needed, I have the facility to provide oxygen if required, and I will scrub out to control the situation as necessary. I'm sure that won't be likely, as knowing the beast allows me to control the beast and tame it.
So I happen to meet Loo, the chap I've been buying the stuff from for years. He mentions that some Aesthetic doctors doing Vasers in Singapore have been buying pumps and Propofol from him. Well, it was only a matter of time. Most have had as much experience with liposuctions as with Anaesthesia (read: none), but that won't stop them. Anyway, Loo recounted stories of flow rates being moved up so slowly no effect was seen. That's just funny. Then he said one patient's BP crashed. Not so funny anymore. He's decided to stop selling pumps and Propofol to Aesthetic doctors. He wisely does not want to be around if disaster strikes.
Is sedation with Propofol such a big deal? Well, I think it is. Many Anaesthetic trainees (even senior ones) would stress at giving sedation with this drug in a clinic setting. There is a very fine line between deep sedation and general anaesthesia. Propofol is used for both. It is my drug of choice for induction of general anaesthesia. It is used alone in a technique called total intravenous anaesthesia (TIVA). Difference between TIVA and deep sedation? Not much. Patients deeply sedated are effectively anaesthetised.
When I use Propofol for WAL, I stop the drug or slow it right down once I achieve my desired end point. The patient remains responsive and is able to turn from side to side as instructed.
And the really cool thing is, the sales rep for Body Jet says that other than one case under sedation, all the other water lipo cases she has attended have been done under general anaesthesia. And we have shown that that is so unnecessary. Hardly any sedation is required!
Used properly, this drug is sweet. Fast acting, short duration, rapid recovery. Misused, this turns into a beast that stops breathing, crashes the blood pressure, and can be very frightening.
I was in two minds to even bring my residual stock to the clinic, but I'm glad I did. The patient I had to use it on is even more relieved! And my hesitancy? Knowing how quickly it works and how dangerous it is when used without specific monitoring and airway support, I did not want to add risk to a procedure when I was scrubbed and unable to manage the airway if needed. We manage just fine with simpler forms of sedation during WAL. But if it is needed, I have the facility to provide oxygen if required, and I will scrub out to control the situation as necessary. I'm sure that won't be likely, as knowing the beast allows me to control the beast and tame it.
So I happen to meet Loo, the chap I've been buying the stuff from for years. He mentions that some Aesthetic doctors doing Vasers in Singapore have been buying pumps and Propofol from him. Well, it was only a matter of time. Most have had as much experience with liposuctions as with Anaesthesia (read: none), but that won't stop them. Anyway, Loo recounted stories of flow rates being moved up so slowly no effect was seen. That's just funny. Then he said one patient's BP crashed. Not so funny anymore. He's decided to stop selling pumps and Propofol to Aesthetic doctors. He wisely does not want to be around if disaster strikes.
Is sedation with Propofol such a big deal? Well, I think it is. Many Anaesthetic trainees (even senior ones) would stress at giving sedation with this drug in a clinic setting. There is a very fine line between deep sedation and general anaesthesia. Propofol is used for both. It is my drug of choice for induction of general anaesthesia. It is used alone in a technique called total intravenous anaesthesia (TIVA). Difference between TIVA and deep sedation? Not much. Patients deeply sedated are effectively anaesthetised.
When I use Propofol for WAL, I stop the drug or slow it right down once I achieve my desired end point. The patient remains responsive and is able to turn from side to side as instructed.
And the really cool thing is, the sales rep for Body Jet says that other than one case under sedation, all the other water lipo cases she has attended have been done under general anaesthesia. And we have shown that that is so unnecessary. Hardly any sedation is required!
No comments:
Post a Comment