Propofol

Doctors first speak to patients before surgery to establish sort of positive expectations and emotions.

During surgery, the drug propofol is used as part of the anesthetic cocktail.

Propofol is associated with higher dreaming frequencies.

Anesthesiologists also conduct continuous monitoring to really precisely track sedation levels and allow for gradual controlled emergence from sleep.

And then once awake, patients are interviewed almost immediately before the dreams are lost.

[laughs]

[singing] Propofol, checkin' my veins.

Checkit, uh.

Goin' down.

There's a few different medicines that they use.

They're pretty standard anesthetics like Propofol or Atomidate.

No one cares about these names.

Okay.

quickly so this is a pretty interesting change up there yep so mechanism of action you know this works by being a positive allosteric modulator of a gaba a receptors with additional direct agonist activity at higher concentrations like you mentioned it has that milky color its effects the main effects that we know it as i think most people if you were asked to Off the cuff, what propofol does, you'd say that it's a hypnotic, so it induces hypnosis or sleep, causes unconsciousness, and then it does have some amnestic effect, which probably we think of more of the benzos and versa doing that, but there is some amnesia effect there from propofol as well.

Pretty much devoid of analgesia effects, so not going to get the pain relief, but you will get sleep induction and hypnosis quite strong.

What is on your list of things that make Propofol unique? It's

got a very, very quick onset.

It's pretty much focused directly on that sedation.

It has so many different roles.

Not only is it good for providing anesthesia, but it's a good medication for basically responding to emergencies during cases.

And I mean, if you don't feel comfortable pushing Propofol when you're having a laryngospasm, for example, or in the case that you would need to intubate, I think that that wouldn't be ideal.

It is...

Propofol's a fucked up drug.

As someone that has been under it a couple times, it messes you up and, yeah, you feel like you're asleep, but he's never been asleep.

Like, for going to sleep, he administered Propofol, Lorazepam, and Midazolam.

Fucked up shit.

You see, that would be, like, that's, like, an interesting thing to show.

Michael Jackson, those guys.

Are you kidding? Propofol, those guys.

There's no way.

Give him the milk.

I think that we also analyze in that case the operator training and we made a very nice observation.

So when the person who intubates critically patients is an anesthesiologist, he or she more commonly uses propofol, while if the intubator is an intensivist or an internal medicine or a pneumologist, the choice is more commonly ketamine or etomidate.

So, uh, I think that, uh, probably the reason is that, uh, anesthesiologist uses Propofol every day in, uh, every, uh, single, uh, case in the operating room, uh, and, uh, everything goes, uh, smoothly.

And I think that I am not saying that Propofol is the devil in, in that case.

Uh, but the problem is that, uh, critically patients are very different and, uh, uh, What works for the anesthesia cases does not work for induction of critically patients.

So I think that we should work probably more to point out these factors.