propofol For ecv weird side effect. Did you ever get it?

It’s now 18 days between each high tachycardia. Soon it will be daily. Last time was 180-190 flutter which I was ecv, time before was >200 STV. I was wearing a holter and it clocked it at 244.

Today’s tachycardia just got worst with symptoms so I took a Valium and low sodium v.8 snd I was hoping to self convert. Didn’t work. After 2 hours of 160 hr I went to the ER. Just earlier the patient before me also had tachycardia but after they triage me I was immediately given a room and was prepared for the ecv before her.

Now weird thing- they gave me a 40 push of propofol with 60 in the syringe just in case and I never closed my eyes. I didn’t blink. I was in a blank trance. I was told they were talking to me and snapping their fingers and waving their hands but I was unresponsive.

Today marked my approximate 33 ecv. This is a first. Also I usually try a Valium beforehand and never got the zombie blank stare before.

Any suggestions why? This is just weird.

In addition to causing a loss of consciousness in sufficient doses, propofol also causes amnesia. That and the fact that it's a white liquid is why it's known as the "Milk of Amnesia." So you can't trust anything you remember (or don't remember) after that first injection.

I must say I don't understand their dosing procedure if you remember correctly. I'm quite sure 40 mg wouldn't knock me out (takes at least 90) but I'm also sure it would leave me zombified. I don't get what they were trying to achieve. It's a short-acting drug, so usually it's given all at once to knock you out, they do whatever needs doing, and then they let it wear off. I've never heard of pre-medicating with it. You sure you trust your memory on that? You probably shouldn't.

This would be a good question for the Dr's and Nurses who are present at alot of ECV's. I have watched a number of ECV's on Youtube, and their eyes are open numerous times. From what I can tell the patients are kind of "out of it" and don't remember afterward, and sometimes they even speak right after the blast. I had this happen one time, and I think that even though my eyes were open, they thought I wasn't really conscious. In fact I was very relaxed, but fully aware.
I was a massive brutal but brief blast. Several other times, I was knocked out, but the blast brought me aware immediately, as one times the blast went through my neck and head. (not good, unintended brain electroshock treatment).

As for the Propofol dosage, 40 seems awful low. I would try to keep track of how much they are giving you, and also let them know next time that it doesn't take much of a dose to knock you out. Although I have only asked them or found out about the dosage on a fraction of my 42-43 ECV's, I know I have had at least 120, up to 160. I think they are immediately pushing well over 40 into me on my ECV's.



Edited 1 time(s). Last edit at 03/03/2021 04:34AM by The Anti-Fib.

You see those patients on youtube with their eyes open because a lot of ERs use conscious sedation instead of full anesthesia. They're not fully knocking them out, which is why you often see them groan and gasp when the shock is delivered.

Personally, I think using conscious sedation for a cardioversion is borderline barbaric. There's just no reason to do something that painful without full anesthesia. I've been cardioverted well over a dozen times and wasn't aware of any of them, but ask Shannon sometime about the doc who converted him before the nurse was done injecting the propofol. It's brutal.

Quote
Carey
In addition to causing a loss of consciousness in sufficient doses, propofol also causes amnesia. That and the fact that it's a white liquid is why it's known as the "Milk of Amnesia." So you can't trust anything you remember (or don't remember) after that first injection.

I must say I don't understand their dosing procedure if you remember correctly. I'm quite sure 40 mg wouldn't knock me out (takes at least 90) but I'm also sure it would leave me zombified. I don't get what they were trying to achieve. It's a short-acting drug, so usually it's given all at once to knock you out, they do whatever needs doing, and then they let it wear off. I've never heard of pre-medicating with it. You sure you trust your memory on that? You probably shouldn't.

I ask questions before and after. I don’t remember anything right after the propofol except the Rn asking me if I was ready, the doctor saying maybe I should count down (I didn’t) and me getting that buzz. I asked beforehand what my propofol dosage and joules will be? Since I am a frequent Er patient, the dr yesterday said he looked up my past dosages and it was 40-60 so he told me he will keep 40 to start because it had worked in the past when I had Valium. While awake he told the Rn to fill up the syringe with 60 but they were going to start with 40 because I had earlier taken a Valium. Plus I don’t weigh much.

And no Carey I don’t remember after the injection. The only reason how I knew about the zombie look and they waving and snapping in my face and I didn’t blink was because they were laughing about it when I was ready to leave. It was the first time for me.

My memory was pretty clear. A paramedic student asked if he could observe the ecv because he was in a 10 month program and he was there that day. Nice guy (Mike). We had a discussion beforehand about his program and afterwards if he ever delivered a baby or saw a severed limb yet and if my body jumped during the zap. I was his first ecv and he was chatting. The RN told me how I was a zombie. The paramedic student had left the room by then so his comment wasn’t a teaching observation for Mike.

So Carey- I was not asking or even curious about amnesia, I had Mike and the RN afterwards telling me that I was not blinking and had my eyes open. It appeared the RN remarking in surprise how I didn’t just nod asleep with my eyes shut. Thus my question how common it was. They were trying to achieve to sedate me for an ecv.

What do you mean using it to premed me? That was my only sedation I had. Plus they gave me nausea med because I had eaten 3 hours prior.

Update: I googled dosages:

[www.hindawi.com]

1.1mg/kg. That would be 59mg for my weight subtract the variance of the effects of the Valium. So he did put 60mg in the syringe and started with 40 which worked the past dozen times because I always take a Valium during high tachycardia to attempt to self convert. So maybe for me it was the right dosage based on my weight but you may need more based on your weight.



Edited 1 time(s). Last edit at 03/01/2021 10:25AM by susan.d.

PS
The Er dr wanted brevital instead of propofol. Is it safer or better?

I understand you're going to require a lower dose than someone like me, but I don't think 40 of propofol would fully anesthetize almost any adult, so it's no surprise to me that it didn't. It was just the way I interpreted what you wrote. Going with a lower dose because of the valium makes sense, but I think he went too low.

As for Brevital, it's not better or safer, and it's a barbiturate so it wouldn't leave you clear headed afterwards like propofol will. Personally, I don't think there's any drug superior to propofol when it comes to relatively short but highly unpleasant procedures. Propofol is like a light switch for your brain. On/off. You go out like a light and you come back just as quickly. And 15-20 minutes later it's like you never took anything at all. I think it's one of the wonder drugs of the 20th century.

I agree about brevital. I take Lyfts for 30 minutes home, sometimes at night, and I prefer to be awake with a joker driver than in a semi amnesia state.

Regarding dosage-I don’t remember being awake fried yesterday or in the past and I quizzed the paramedic if my body jerked, etc. He has yet to learn to watch what he says and he told me about my body jerking but he didn’t tell me I was yelling in pain. I had to been out otherwise he would had told me.

Out of 33 ecvs , 40mg has been the norm in 40-50% of my ecv’s. 60-75mg is common (without a Valium) and once or twice it was a lot more because the first 50 joules didn’t work so she did it again at 150 joules and gave me a lot of propofol. Now it’s always 100 joules and 40 or 60mg depending on the dr and if on Valium. The past 3 times were 40mg. Except for my first ablation of 200,200,200 and 300 joules and I had stronger type sedation. Plus it depends on the ER. The one near me used 75mg and my current Er uses less.

I honestly can’t wait for my next ablation. I can’t see going again to be ecv. I had my 2 month tele appointment with my local ep today. he looked at my 12 lead from yesterday and told me never to wait 2 hours before heading to the ER but be at the ER no later than an hour from onset. It was not yesterday but 19 days ago I was in bad shape with dripping sweats, angina and nausea with my 180 hr and I speculate they got me into a room and zapped in record time. I don’t even remember being sedated. Just waking up to a 49 hr. The ER also paid for someone to drive me home for free.

Yesterday and 19 days ago I broke my front teeth during the ecv. I don’t know how because I was told they put a guard between my teeth. Also bad burns again. Lately my burns heal only to get zapped again.

Anyways I wish my ablation is this month and not next. I feel like I’m on call because every time I eat a meal I worry if I go into af/flutter/STV it will delay my ecv. Not yesterday. They gave me zofran and zapped me, but some doctors wait. I don’t do well with chemical conversations. I’m allergic (caused a type 2 MI) to adenosine and it doesn’t work. He did it 3 times. Yesterday they wanted to try cardizem but I recalled my local ep saying it won’t work and always get an ecv.



Edited 1 time(s). Last edit at 03/01/2021 08:54PM by susan.d.

I promise your body jerked. You don't come off the table or anything like Hollywood would have you believe, but there's definitely a body-wide jerk, even with people in cardiac arrest. I was cardioverted 2 days after my first ablation, and the muscle contractions were strong enough to cause my left insertion site to open up and begin bleeding.

"Yesterday and 19 days ago I broke my front teeth during the ecv. I don’t know how because I was told they put a guard between my teeth. Also bad burns again. Lately my burns heal only to get zapped again."

Some of the gaurds are hard plastic, if they even really used one. Try to get the kind with foam over the plastic.
I take my own bite gaurds now (mouthpiece, bite block). It's one of the 3 things on my list to tell the Dr's/Nurses prior to getting ECV'd. I found that often the ER's didn't have a bite block available, so now I bring my own. One time they improvised, using rolled up gauze pads. Anyway one one of my first ECV's 10 years ago, I severely bit my tongue. Then 3-4 years ago, when I had an ECV done, I pulled out a used Bite Block from before, and told the Nurses about the story. One of the Nurses was there when I bit my tongue years ago, remembering it well, and she went and fetched 4 new blocks for me to use in the future. So now I have a collection of 3 new blocks and 5 used ones.

Thanks anti-fib!
I broke both upper and lower front teeth 20 days ago from a ecv and had them bonded filled. Then Sunday the upper broke again during the ecv. I woke up spitting out enamel. I returned to the dentist today again. He didn’t charge but I could tell although he has a year warranty, this was not normal wear and tear and he didn’t look happy. He told me instead of getting anterior guards at the Er, ask for posterior...like I had a choice. Each time he has to adjust my mouth guard after a new dental prosthesis. I had brought my hard plastic custom mouth guard with me in to the Er in the rare chance I would get admitted but I honestly didn’t know they even put in a bite guard so I didn’t mention it. The student paramedic told me they used a bite guard. I never saw it in the room. I never knew they used them. Why don’t they put them in before the sedation? During an endoscopy it’s in beforehand.

I’m afraid if I use my own (I grind my teeth), it could get lost and it takes 3-4 weeks to get a new one.

What do they do during an ablation? They tube and I was ecv 4 times during the first ablation. Won’t a bite guard take time and how will it fit around the tube?

I’m going to look at Amazon for a soft mouthguard. Thanks.

If they used a Bite Guard, they should have put it in before they pushed the Propofol. As you know they zap you pretty fast after your under. I have one of these, it has foam around it. [www.bing.com]

It's about 1 1/4 " thick, so hard to get much force through momentum of mouth closing down.

Nobody in my 33 ecvs ever inserted a mouth guard before the propofol push. This last time I was told afterwards they put it in after the push. It doesn’t make sense since propofol is short acting.

I've never seen or even heard of a bite guard being used, and I've seen a lot more than I've undergone myself in EMS. Must be a local thing.

When I woke up the Rn was in the room. I started to spit out tooth enamel onto the palm of my hand and showed it to the Rn with the comment I made that this was two in two that the ecv broke my teeth. He shook his head and said they put in my mouth a mouth guard after the push. It didn’t make sense because propofol is short acting and why waste time after the push instead of beforehand during the prep?

I agree with you Carey. They always ramble the “script” on what they are going to do and never mentioned inserting a mouth guard.