Procedural anesthesia

[ceecel.dee, MSN, RN]

This has become the recent "hot topic" in our rural hospital.

What are you commonly using to sedate, say, peds patients, for suturing? How are you monitoring them (above and beyond frequent VS with O2 sats)? How many staff members present? Do you require the physician to be, and stay present during induction and throughout the begining of recovery?

All comments welcome!

:)

[jayne109, RN]

I don't work in the ER in the small hospital I work at but I have a Good colleague who was trying to find pharmacy tech the other day to get a refill of Ketamine. I asked him what he had used just 75mg froma 400 mg vial for and he said that 75mg of ketamine makes a kiddo sleep comfortably through suturing and it lasts just long enough for suturing. I think they even used it for a CT scan once or twice. I thought that was pretty cool.

[kmchugh]

See my comments on the "Etomidate" thread. You should not be doing anesthesia unless you are qualified. Ketamine? Why on earth anyone not experienced in anesthesia thinks it OK to just give some ketamine so kids "sleep through procedures" is beyond me.

I'm not trying to flame or belittle anyone here. But, be very aware, every anesthetic induction agent has the ability to kill, and the difference between "sedation" and "dead" can be a matter of a few milligrams. I don't administer ANY of these drugs without proper monitors, proper emergency medications drawn up and ready to go, and intubation supplies out and ready to use. If the patient goes bad on you, who do you think is going to get sued? As bad or worse, how do you plan to defend yourself to the state board of nursing when they ask why you, who is not trained in anesthesia, were administering anesthetic agents to patients?

Kevin McHugh, CRNA

[mynika]

" be very aware, every anesthetic induction agent has the ability to kill, and the difference between "sedation" and "dead" can be a matter of a few milligrams. "

As trained nurses we are allowed to administer certain drugs that cause "concious sedation" as directed by our hospital policy. We are well aware of the effects of these medications and are prepared to deal with issues that arise just as we are prepared for the effects of ALL medications we administer. Insulin has the ability to kill and the difference between effectiveness and dead could be a matter of a few units. Want to come push all my insulin? Give my potassium solusets? Adjust my dopamine and insulin drips? Any time I administer drugs causing concious sedation these patients are monitored and there is a doctor and a crashcart with intubation supplies at bedside. It would be lovely if there were a CRNA at bedside too but as this is not happening I will continue to give the care my patients need during these proceedures.

[CougRN]

I have seen oral versed given to children for procedures. But there was always an anesthesia provider present.

[canoehead, BSN, RN]

We give Versed po or IV with nurse 1:1 and cardiac, bp, sat monitering and a bag, oral airway and suction available. Vitals q5min until the procedure is over. Doc needs to be present before we start sedating, and RN at bedside until the recovery period is over.

[wayover20]

We give Versed po or IV with nurse 1:1 and cardiac, bp, sat monitering and a bag, oral airway and suction available. Vitals q5min until the procedure is over. Doc needs to be present before we start sedating, and RN at bedside until the recovery period is over

.....DITTO.

We consciously sedate (hmmm another for the oxymoron thread) also with fentanyl or brevital. But at all times everything is out and ready to resuscitate if necessary. And Ketamine is frequently used with pedi's. Nothing new there.

[wayover20]

......and no anesthesia nurse/dr. is used. We sedate and tube without them in code blues so this is no different.