[canoehead]

I am outraged that a doc would leave a patient in pain, and insult them. I also think that the fact that you said "stop" repeatedly and they kept going is grounds for a suit. I would be very clear about what "stop" means before allowing sedation again. I don't blame you for being upset.

Are you going to get to talk to this doc again, maybe ask why he didn't respond to your requests?

[swmn]

I draw up 5 and 100 when I am using Versed and Demerol, 10 and 250 when I am using Valium and Fentanyl. Drope comes in 5mg ampules, so that is a no brainer too.

When it is my turn, I want fentanyl and versed. On integrated units where recovery is handled by other endo procedure nurses I would say 50 of demerol and 3-5 of versed is pretty typical with gentle docs and healthy outpatients. Females who have had lots of babies might need 75 or even 100 of D, but all these folks will recover and walk out pretty quickly.

Anyone on maintenance opiods or benzos for pain/panic etc is going to be a little tougher to sedate. Anyone taking about 30mg morphine or 10mg diazepam PO at a single dose is going to make my short list for droperidol, along with everyone who drinks alcohol everyday or is currently using marijuana, cocaine or crystal meth. The "seekers" asking about vicodin for the post procedure pain they haven't even felt yet frequently make my drope list too.

If there are some pulmonary issues to consider I'll go heavier on the versed and layoff the D. Patients on maintenance valium I lean away from the versed and push the D a little harder (if I can't talk the doc into using fentanyl). Those little lines on the 5cc syringe of versed are 0.2mg each

Frankly I dilute my Demerol to 10mg:1cc in a 10cc syringe and will go with 2mg incremental doses if it is indicated. My smallest dose on an ancient inpatient was 0.6 of valium and 12mg of Demerol for a very long colonoscopy. Sometimes I can time 5 of versed, 100 of demerol _and_ 5 of drope to all peak at the same time and still have to talk the patient through an EGD.

For obese patients without respiratory compromise I am more than happy to start with 2&50, and then run the versed up in more or less a hurry.

Don't forget to use Starling's Law to advantage when you sedate without fluids hanging. Starling is my friend.

Still have to find my calipers to comply with the latest safety warning about droperidol, went up on fda.gov on 12-05. Gosh I want to be inserviced on propofol.

[swmn]

I have noticed in elderly patients onset times are delayed compared to younger patients. I don't have any firm rules yet about when to switch from doses at 2 minute intervals to 3 or even 5 minute intervals, but I do have some guidelines. Anyone over 80 yo, 3 minute intervals is as fast as I will push. 3 minutes goes for lots of folks in their 70s too.

60s is kind of borderline, I guess mostly I am guessing how much longer this patient is going to be coming in for elective procedures.

I have noticed redheads tend to have delayed onset times earlier than brunettes, so redheads over 70 I treat like brunettes over 80. Seems to work OK.
There are a couple other groups I take my time with. I don't see very many, but every once in a while I get to sedate a Basque. I am not going to say they have "funny" names, just unfamiliar combinations of letters in their family names, and it seems to take a little longer for whatever dose I give them to reach peak. Really nice people too, usually. Another one is patients over 100 years old. The few I have seen coming in for elective procedures usually look better than my dad, and he is only 58. Centurions generally tolerate meds pretty well, but I conciously use 5 minute intervals when sedating them just because they have come so far I wouldn't want to be "the one".

[TeresaLRN]

Our GI doc does a very nice job of keeping pt. comfortable with 60mg of demeral and 2-4mg of versed for colonoscopies and 50mg demerol and 2mg versed for EGD. Of course the dose varies with pt. age and size. We have a surgeon that uses the fentanyl and I don't like it as well as the demerol. The surgeon has gotten better at medicating. There were times I was giving 300mcg of fentanyl and 8mg versed to the same person!!! Docs need to allow the meds to kick in before rushing to start the procedure. The pt. are more comfortable.

[carol a smith]

average in our dept is probably demerol 100-125mg with versed 2-5mg. have give up to 175mg with versed 7 mg once.

[NurseDennie]

OMG I wish I hadn't read THIS thread!!!! Pmenrs's post has scared me to death! I've got to have one done next week sometime, and I'm fat, too!!!!

I'm fat, but I should be fairly easy to put under. I want to be completely snowed now!!

Love

Dennie

[NurseDennie]

Eeeeek - I just read swmn's post. I'm redhead, too!!

I think I need some Versed NOW!!

Love

Dennie

[formernurse]

I have had 4 colonoscopies in the last 4 years, and can only remember one time when I felt a fair amount of discomfort. Thankfully, my GI doctor is a very caring and compassionate lady who takes her time and listens to my concerns. Am very sorry to hear that you had so much pain with your scope. Be sure and let you doctor know that you were displeased. I recently had surgery under local anesthesia with hypnosis, and that worked beautifully. This week I had a root canal and used hypnosis alone. That. too, was a complete success. The next time I am scheduled for a c-scope, I'll also use hypnosis. Don't give up on having scopes--they can save your life by screening for colon cancer.

[Classy]

On Thursday, I had an EGD which was extremely uncomfortable. I've had them done prior to this without a problem using Demerol and Versed. Last fall, I had a colonoscopy where they didn't feel that I was sedated enough because I was wide awake even with a very high dose of Versed. I was comfortable for the endoscopy the entire time. A few weeks after that procedure, they did an ERCP under general anesthesia based on their concern about the inability to get me fully sedated for the colonoscopy previously.

I mentioned the above incidents to the sedation nurse and told her that I believed I would need a high dose of Versed for this procedure. The sedation nurse insisted on using Fentanyl and Droperidol only instead. She claimed that the Droperidol would make me very sleepy so I wouldn't feel anything. Even though I was very drowsy during the procedure, I felt and remembered everything. It was a horrible experience! I couldn't talk due to the mouth guard but was moaning and gagging uncontrollably the entire time. I felt every movement of the endoscope also which was very uncomfortable and somewhat painful. I didn't know how to get them to stop. Afterward, the sedation nurse claimed that I was so uncomfortable because I had an overactive gag reflex. But I don't ever remember gagging in the past during my previous 4 EGD's. Despite being so uncomfortable during the procedure, I was much more sleepy afterward this time which I assume was from the Droperidol. I couldn't seem to wake up and slept for the next 12 hours straight. In the past, I felt awake and really good almost immediately afterward.

I haven't discussed this incident with my doctor yet. I was still very sleepy yet when he talked to me on Thursday. I have an appointment with him in 2 weeks where I plan to discuss it.

Since I have Barrett's Esophagus, I know I need surveillance frequencies on a regular basis. But I am now dreading having this done ever again. I'm also a rape survivor with PTSD. Prior to this EGD, my PTSD was very well controlled. Since the EGD, I've been crying uncontrollably and having numerous flashbacks again. This EGD experience felt very much like getting raped all over again. I believe it has resulted in me being retraumatized.

I also see that someone mentioned that antidepressants may affect sedation. I am on strong antidepressents due to Severe Major Depressive Disorder which I just received Medical Disability Retirement for. I'm on Lamictal, Wellbutrin, Synthroid, Zyrtec, Vitamin D and Nexium. I've recently been taken off of Reglan by my doctor and psychiatrist due to the depression and suicidal ideation side effects.

In your experience is using only Fentanyl and Droperidol an adequate sedation for most people with EGD? Is that as effective as Versed and Demerol for conscious sedation? Do you know if any of these medications are contraindicated for severe depression?

Thanks for reading my long letter,
Classy

[robrn]

We use propofol for sedation and our MD’s guarantee a painless procedure. To this date we have had no complaints, from our patients. We start with 30 to 50 milligrams of propofol then give incremental doses of 10 to 20 milligrams depending on the patient’s response. Propofol is very predictable fast acting and rapidly dissipating. I have found Versed and Fentynl doses are all over the map, depending on the patient’s previous exposure to benzos and narcotics.