Method - PROPOFOL -

[Suez]

I'm from Turkey man. Thanks but I have not medical experience. I chatted with several anesthesiologists. They gave me the information I needed. I am grateful to them.

Yes bupivacaine is the local anesthetic with the highest cardiotoxicity. According to experiments in rats, LD50 in humans is estimated at 1mg / kg. Rapidly injected 500 mg bupivacaine can cause acute bradycardia and cardiac arrest within seconds. I have not come across any case reports on this matter.

Your from Turkey, awesome. Ive never made it to Turkey in my travels around the world but ive come pretty close to it. I went to Cyprus about 10years ago so i was kinda close to you. For someone with no medical experience, whose only gained medical knowledge from reading and talking to anaesthesiologists, you have an incredibly good grasp of both the terminology and also the clinical aspect of both pharmacology and phsyiology, your amazing, you really are and I am a qualified MD and I also hold a PhD. Yes your absolutely correct about the toxicity of Bupivacaine but there are many many articles about it. I have pasted in just a couple of them. Cardiotoxicity , Myotoxicity&Neurotoxicity is a problem with local anaesthetics in general. They call it Local Anaesthetic Systemic Toxicity (LAST)It was first identified about 100 yrs ago when they first started noticing deaths attributable to local anaesthetics. I think it was in the 1920s when they found about 40 deaths due to Cocaine (which back then was legal and was a commonly used local anaesthetic).
http://jclinmedcasereports.com/articles/OJCMCR-1188.pdf https://www.scielo.br/scielo.php?pid=S0034-70942011000100012&script=sci_arttext&tlng=en https://anesthesiology.pubs.asahq.org/article.aspx?articleid=1943528

You can't bolus too much in the sense that you won't have any other reaction than circulatory collapse. If you are still conscious after a fast 10ml bolus, why not use more? Were it me, I would want to pass out while pushing.

Yes Im aware of that, so if you cant bolus too much, then what dose would you recommend starting off with???

 

[Sunset Limited]

Like I said, bag on, immediately start drip, as soon as drip running, push a large bolus until unconscious. As for does, I would say as much and as fast as possible without blowing the cannula.

if unfamiliar with dosing, you likely will have extreme difficulty inserting a cannula (one handed and backwards from placing it in another person)

Adding SN isn't needed or Really fit, as the bolus would either do the job, or one would wake up and then have to deal with the SN and possibly aspiration into lungs, which would likely be extremely painful.

Hi man. My SN + propofol plan is as follows:

- Drink SN

- After 5 minutes open up roller clamp and start drip infusion (1400 mg ends in 20 minutes) As I read, in the maintenance of anesthesia with propofol dosing is 150 to 200 mcg / kg / min, if 1400 mg ends in 20 minutes, that means 700 mcg / kg / min (I am 100 kg). This dose should be enough to make me unconscious.

- Open up roller clamp of injector (600 mg bolus)

With this plan, my propofol infusion will be finished 25 minutes after I drink SN. So I should wake up about half an hour after drinking SN. I don't think this will happen because the level of methemoglobin will be over 60%. SN knock down a person about 15 minutes after drinking. My plan is that but still I want to do it by 2000 mg in 1 minute. I don't think anyone can survive with this dose. All the anesthetists I have discussed agree that it will result in cardiovascular collapse.

 

[Suez]

You can't bolus too much in the sense that you won't have any other reaction than circulatory collapse. If you are still conscious after a fast 10ml bolus, why not use more? Were it me, I would want to pass out while pushing.

You must have an idea as to what bolus does to start with then? What do you mean circulatroy coolapse?

You can't bolus too much in the sense that you won't have any other reaction than circulatory collapse. If you are still conscious after a fast 10ml bolus, why not use more? Were it me, I would want to pass out while pushing.

Thats weird i thought i had replied to this but my reply never went through. Anyway, please can you suggest a bolus dose that is not too much then??? What do you mean circulatory collapse?

 

[Sunset Limited]

It's time to sleep buddies. Thanks for chat. The sun has already risen here :)

 

[Suez]

It's time to sleep buddies. Thanks for chat. The sun has already risen here :)

Nite Nite buddy

 

[Aap]

Good luck. Propofol is completely peaceful.
Propofol can cause slowed breathing, low blood pressure, and slowed heart rate. Circulatory collapse would be when an individual stops Or slows breathing, bp, or hr to the extent coding will follow and result in death.

anesthesia induction dose is 2-2.5mg/kg. That would be a minimum. This dose would put an individual to sleep and may or may not require assisted breathing. I'd use a multiple of this.

 

[laserfocus111]

Thank you for sharing your thoughts..

Good luck and peace be with you.

It's time to sleep buddies. Thanks for chat. The sun has already risen here :)

Good luck. Propofol is completely peaceful.
Propofol can cause slowed breathing, low blood pressure, and slowed heart rate. Circulatory collapse would be when an individual stops Or slows breathing, bp, or hr to the extent coding will follow and result in death.

anesthesia induction dose is 2-2.5mg/kg. That would be a minimum. This dose would put an individual to sleep and may or may not require assisted breathing. I'd use a multiple of this.

Hi Aap, what's about midazolam? Would it be peaceful (in combination with other methods)?

 

[Aap]

It's not needed, and alone benzos are actually very safe alone. Sure, there are situations it could conceivably help (bag over head and then large dose Iv to cause sleep or added to an opiate OD), but in general I wouldn't mess with it.

It's not that it wouldn't be peaceful, it relieves anxiety.. it just works very quickly and can drastically alter motor or mental function (amnesia, slowed thinking). There are some things I would not want to attempt while sleep walking.

 

[laserfocus111]

I finally got my hands on propofol and bupivacaine as @ThatsEnoughForMe suggested.

I'm planning to mix everything up in a few bags (propofol, bupivacaine, lidocaine, midaz and fent) and administer over 3 different IV sites, and add on oral propranolol 16g beforehand.

Should be good.

 

[Aap]

Wow, congrats. 16 grams of propranolol? Given the dose, I assume you will have all lines ready to go, drink propranolol, and then immediately start the infusions? If not, you may find the propranolol will cause discomfort or incapacitation quickly and prevent you from getting all the meds going.

you seem set on a course, but think carefully how you are going to use the lidocaine and bupivacaine, as they can induce severe nausea (and are obviously cardiotoxic). Obviously incapacitation can be very, very quick with the propofol or fentanyl/midazolam combo, but you definitely don't want to be conscious when you feel the effects of the local anesthetics overdose.

 

[laserfocus111]

thank you. I've taken propranolol up to 80mg for anxiety but I think it's still mild.

Will push a IV metoclopramide 30mg bolus before starting on anything, and maybe take 120mg of propranolol first while setting up the lines and mixing the powdered propranolol into a bottle of warm water.

I guess I've got to make do with what I have..

 

[Aap]

Do you actually have everything you've listed (propofol, f, midazolam, and the local anesthetics)?

 

[Sunset Limited]

thank you. I've taken propranolol up to 80mg for anxiety but I think it's still mild.

Will push a IV metoclopramide 30mg bolus before starting on anything, and maybe take 120mg of propranolol first while setting up the lines and mixing the powdered propranolol into a bottle of warm water.

I guess I've got to make do with what I have..

Gratz buddy. Is propofol %1? Now you have a business class ticket to leave that hell. I think you don't need propranolol tablets. Bupivacaine and lidocaine is enough and don't mix propofol and lidocaine because maybe propofol emulsion could be broken. Also you can keep propofol in the refrigerator (2 - 8 °C) Propofol emulsion will be broken at +24 °C. Water and soybean oil (propofol) will be seperated.

 

[Aap]

Excellent advice as usual.

 

[Suez]

Maybe not best way but really painless and peaceful. Hmm i dont know about that but propofol causes respiratory depression. So there is a risk of being a vegetable.

Anesthesiologists say that 400-500mg propofol is fatal without mechanical ventilation. Im planning to use 2000mg. We have an expression around here. Attaching the donkey to a sturdy stake :)

In the following video we see that the patient needs mechanical ventilation with only 150 - 200 mg propofol. It is impossible to survive with 2000mg. A really peaceful CTB




Exactly as you said. This is the favorite CTB method for anesthetists and anesthesia technicians. This forum seems to get stuck in more popular ways. I explored this method myself. Im sure there are more methods hidden. For example N. N is really hard to find and you must be sure about purity or is it N or something? Needs analysis. There is bad taste and vomiting problem also. Propofol is better. Cheap, more accessable. All you need is IV.

Hello my friend, as you already know, I'm very much with you on this one. The gravity fed system you designed I believe is the way to go. Eliminates the "How much can I use bolus" It removes all the other additional "steps" in methods like SN where there is continual discussion about dosing, half lives,antiemetics,antacids etc. Propofol is a much cleaner CTB method. Altho yes you can add Opiods for instance for that extra assurance, Propofol on it's own has proved to be more than effective.Your system is really well designed and uses simple materials, just a matter of obtaining some 60ml syringes, tubing etc and of course getting gd vascular access. Three ports seem to be popular and is most likely what I would go for as well.
Anesthesiologists know how to get it right, that's for sure, you has some gd sources here. What a genius tho putting it together, I cant remember whether I asked you regards syringes, did you find 60ml best for your system?

 

[laserfocus111]

Do you actually have everything you've listed (propofol, f, midazolam, and the local anesthetics)?

Fentanyl 1mg
Midazolam 75mg
Propofol1% x 100ml (on the way)
Bupivacaine 0.5% x 10ml (on the way)
Lidocaine 2%, Propranolol, metoclopramide IV - no limit on supply


@ThatsEnoughForMe
Thank you for the advice. I didn't think about it!

 

[Aap]

Well you certainly have enough to be fatal several times over. I'd make the local anesthetic line as distal as possible (calf or foot) and open the line last if you are turning everything on at roughly the same time. Are you going to just gravity feed or also use a bolus dose into the IV line.

if your IV lines do have a port to inject into the lines, I'd have one in each arm and afteR turning everything on push an induction dose of propofol in one and f/midazolam into the other. Not required, but not a bad idea.

 

[laserfocus111]

Well you certainly have enough to be fatal several times over. I'd make the local anesthetic line as distal as possible (calf or foot) and open the line last if you are turning everything on at roughly the same time. Are you going to just gravity feed or also use a bolus dose into the IV line.

if your IV lines do have a port to inject into the lines, I'd have one in each arm and afteR turning everything on push an induction dose of propofol in one and f/midazolam into the other. Not required, but not a bad idea.

Thank you, I understand the LA line is to be as distal as possible so I would pass out before feeling the cardiac effects of lignocaine/bupivacaine.

It's just me but I was planning on inserting all 3 on my left cubital fossa because I feel having so many lines all over will be pretty messy. I intend to just grab all the 3 valves and turn them on at the same time and let gravity do the work before nitenite. Will need to really secure the lines in case I seize and fk the whole thing up.

The cannula most proximal will be linked to an emptied out 500cc bag filled with midazolam/f/propofol.

The 2 more distal sites will be linked to IV bags containing the LA.

 

[Aap]

Oh glad I asked then. You really need the lines in different locations (e.g. one in each arm and one in leg). You don't want to run the risk of blowing a vein and having the entire procedure mess up.

If you don't want to add a bolus dose, you could reduce the volume of liquid in the propofol and f/m bags. The purpose would be to get you unconscious faster before the effects of the local anesthetics. If not, your rodeo. You certainly have some redundancy built in. Best of luck.

 

[SuiSqueeze92]

Remember Michael Jackson? He had propofol and benzos as cause of death.

He actually died of food poisoning...



Found 8yr old meat in his mouth :P

 

[laserfocus111]

Oh glad I asked then. You really need the lines in different locations (e.g. one in each arm and one in leg). You don't want to run the risk of blowing a vein and having the entire procedure mess up.

If you don't want to add a bolus dose, you could reduce the volume of liquid in the propofol and f/m bags. The purpose would be to get you unconscious faster before the effects of the local anesthetics. If not, your rodeo. You certainly have some redundancy built in. Best of luck.

yeah. I'd empty out the normal saline bags first and then inject the meds directly into the bag.

Maybe I'll place the midaz/f/proprofol site at the cubital fossa and the lignocaine/bupivacaine site at the left wrist dorsum. As for blowing veins up I think I'm pretty confident as I do set lines amongst other things for a living.

Thank you. My date might be soon. Depends on how life goes. Take care.

 

[Aap]

Best of luck

 

[Sunset Limited]

yeah. I'd empty out the normal saline bags first and then inject the meds directly into the bag.

Maybe I'll place the midaz/f/proprofol site at the cubital fossa and the lignocaine/bupivacaine site at the left wrist dorsum. As for blowing veins up I think I'm pretty confident as I do set lines amongst other things for a living.

Thank you. My date might be soon. Depends on how life goes. Take care.

I understand that you are considering a propofol infusion without a bolus dose man. This means a loss of consciousness that will take longer. I read a study with Propofol. Subjects were injected with 2 mg/kg of propofol within 10 seconds and their effects were observed. Thirteen percent of the subjects did not lose consciousness! So just by infusion, loss of consciousness can take a very long time. Propofol is eliminated very quickly in the blood. I would add a bolus dose of 3mg / kg.

Also, if you mix propofol, midazolam and Fentanil in the same bag, the propofol emulsion may be broken. I don't think it will happen in a very short time. But if the emulsion is broken, soybean oil (propofol) will be seperated. You can see soybean oil at the top of the bag. It is unlikely to happen in a short time.

 

[Aap]

That's where I was trying to go. I'd use either one syringe of propofol in one hand and fentanyl/midazolam in the other (especially if he has powdered fentanyl and not medical). If he has 1mg of powdered f, there would be little reason not to administer it all at once. Two syringes of propofol would be my second choice.

as described with no bolus, It is possible, though not guaranteed that unconsciousness will occur before the local anesthetics start causing nausea and heart issues.

 

[Sunset Limited]

That's where I was trying to go. I'd use either one syringe of propofol in one hand and fentanyl/midazolam in the other (especially if he has powdered fentanyl and not medical). If he has 1mg of powdered f, there would be little reason not to administer it all at once. Two syringes of propofol would be my second choice.

as described with no bolus, It is possible, though not guaranteed that unconsciousness will occur before the local anesthetics start causing nausea and heart issues.

Yes buddy absolutely! My plan was like that about propofol and bupivacaine before build my injection system.

2 x syringes
2 x serum bags
2 x cannula
2 x two-way vein valve
4 x infusion sets

200 mg x 2 syringes = 400 mg bolus dose of propofol. 2 x infusion sets for syringes. Connect the infusion set to the two-way vein valve. Cut the part that enters the bag and attach it to the injector. So I will have injectors in both hands. I can push them both at the same time. The other two infusion sets are for propofol maintenance dose and bupivacaine. So my plan was like this. Open the roller clamps of serum bags and start propofol maintenance dose and bupivacaine than push the syringes for bolus. 2 venous access is sufficient. It is difficult to know how long it will take to start anesthesia with propofol without a bolus dose.

Hello my friend, as you already know, I'm very much with you on this one. The gravity fed system you designed I believe is the way to go. Eliminates the "How much can I use bolus" It removes all the other additional "steps" in methods like SN where there is continual discussion about dosing, half lives,antiemetics,antacids etc. Propofol is a much cleaner CTB method. Altho yes you can add Opiods for instance for that extra assurance, Propofol on it's own has proved to be more than effective.Your system is really well designed and uses simple materials, just a matter of obtaining some 60ml syringes, tubing etc and of course getting gd vascular access. Three ports seem to be popular and is most likely what I would go for as well.
Anesthesiologists know how to get it right, that's for sure, you has some gd sources here. What a genius tho putting it together, I cant remember whether I asked you regards syringes, did you find 60ml best for your system?

sorry ı miss your post. I'm not sure about that I understand your question. It's about syringes rihgt? I couldn't find them in the pharmacies but I did in pharmaceutical warehouse. They are standart.

 

[Aap]

Yeah it's a solid plan.

 

[Suez]

Yes buddy absolutely! My plan was like that about propofol and bupivacaine before build my injection system.

2 x syringes
2 x serum bags
2 x cannula
2 x two-way vein valve
4 x infusion sets

200 mg x 2 syringes = 400 mg bolus dose of propofol. 2 x infusion sets for syringes. Connect the infusion set to the two-way vein valve. Cut the part that enters the bag and attach it to the injector. So I will have injectors in both hands. I can push them both at the same time. The other two infusion sets are for propofol maintenance dose and bupivacaine. So my plan was like this. Open the roller clamps of serum bags and start propofol maintenance dose and bupivacaine than push the syringes for bolus. 2 venous access is sufficient. It is difficult to know how long it will take to start anesthesia with propofol without a bolus dose.


sorry ı miss your post. I'm not sure about that I understand your question. It's about syringes rihgt? I couldn't find them in the pharmacies but I did in pharmaceutical warehouse. They are standart.

Thats ok, I couldnt remember what size syringe you had used in your system but i found the PM, you said it was a 60cc syringe.

Gratz buddy. Is propofol %1? Now you have a business class ticket to leave that hell. I think you don't need propranolol tablets. Bupivacaine and lidocaine is enough and don't mix propofol and lidocaine because maybe propofol emulsion could be broken. Also you can keep propofol in the refrigerator (2 - 8 °C) Propofol emulsion will be broken at +24 °C. Water and soybean oil (propofol) will be seperated.

I think they say lidocaine should not be added to Propofol solution in quantities greater than 20mg/200mg Propofol, thats when the emulsion is likely to become unstable. Have you thought about maybe pre-treating the injection site too where the propofol is going in? Propofol can be uncomfortable, burn a bit going in, so you could pre-treat like 1ml of 1% lidocaine to minimzie any pain? This would make things a bit more comfortable.

I understand that you are considering a propofol infusion without a bolus dose man. This means a loss of consciousness that will take longer. I read a study with Propofol. Subjects were injected with 2 mg/kg of propofol within 10 seconds and their effects were observed. Thirteen percent of the subjects did not lose consciousness! So just by infusion, loss of consciousness can take a very long time. Propofol is eliminated very quickly in the blood. I would add a bolus dose of 3mg / kg.

Also, if you mix propofol, midazolam and Fentanil in the same bag, the propofol emulsion may be broken. I don't think it will happen in a very short time. But if the emulsion is broken, soybean oil (propofol) will be seperated. You can see soybean oil at the top of the bag. It is unlikely to happen in a short time.

Because propofol is opaque, its not easy to determine incompatibilities with other drugs visually but ive seen a few papers now where they use (1) an equal volume of propofol injection, (2) an equal volume of propofol injection with methylene blue added, and (3) an equal volume of the separated aqueous phase of propofol injection. The mixtures were observed for physical changes, and the turbidity of the aqueousphase mixtures was measured by nephelometry. Obviously not necessary to test Immunoglobulins, dont expect people to do this but you can certainly make good visual assessments from using this method. Well worth doing if you are thinking about combining different drugs in the same bag as the propofol.

 

[laserfocus111]

@ThatsEnoughForMe
@Aap
@Suez

Wow. I did not realise there were so many considerations. I am using fentanyl citrate (from Janssen) 1mg (1 box).

It looks like I'm back to square one - propofol goes into a dedicated line, while the f/midaz combination goes into a second line while the bupivacaine/lignocaine combo goes into a third line. All the bags are pre-emptied of course.

I'll start by taking 120mg propranolol beforehand, with IV metoclopramide 30mg.
Drink up the powdered 16g of propranolol
Set up my lines properly and undo the clamps. At the same time, quickly bolus 20cc (200mg) of propofol into the most proximal vein.
?nitenite

 

[Suez]

That's where I was trying to go. I'd use either one syringe of propofol in one hand and fentanyl/midazolam in the other (especially if he has powdered fentanyl and not medical). If he has 1mg of powdered f, there would be little reason not to administer it all at once. Two syringes of propofol would be my second choice.

as described with no bolus, It is possible, though not guaranteed that unconsciousness will occur before the local anesthetics start causing nausea and heart issues.

Just a thought, about using a filter for your Propofol? Were you planning to discharge through a filtering needle or similar?

 

[Aap]

Was this meant for me? I don't view a wheel filter as necessary for terminal use or propofol that looks ok and isn't expired.
Laser, that sounds much better.