[TZT]

Originally Posted by chrisf1969

Hi Everyone.
I dont know if this has been discussed, but i would to hear what other endoscopy units, all over the world, do with discharging patients who have had sedation.
In the UK in the unit i work in, any patients receiving a sedative (we use Midazolam), must have overnight supervision for minimum 24 hours.
I would love to her what other units do

I work in the Endo dept. in an upstate NY facility. We keep pts an hour form the last time they were medicated. We also have them sign their discharge papers prior to being medicated that states they will have someone to drive them home. We use Demerol and Versed in the smallest affective dose possible. The duration on these drugs are short acting, 2-4 hours for Demerol and depending on the dosage for Versed 1-5 hours. Some responsibility has to be placed on the pt for their own health and well being. They way hospital are run today, like a business, theres no way we could possibly keep people in over night. That is saved for the pt that needs it.

[MizLisa]

Hello in the unit I work in in Southern California we can discharge pts after being in recovery for 1/2 and their vital signs are within a normal range of their baseline. We also require pts to pass the air from the colonoscopy and have a soft non tender abdomen and to be able to swallow without and pain or difficulty after an EGD. We use demerol and versed. Usually the average does is 50mg demerol 3-4 mg of versed per pt. That is the average. Sometimes less and sometimes more. We are also seeing a trend of pts (especially men) having a colonoscopy without and sedation. They leave after they pass the residual air from the procedure. A 24hr stay is excessive and versed is pretty much metabolized in about 20 mins. Good Luck! Lisa

Originally Posted by chrisf1969

Hi Everyone.
I dont know if this has been discussed, but i would to hear what other endoscopy units, all over the world, do with discharging patients who have had sedation.
In the UK in the unit i work in, any patients receiving a sedative (we use Midazolam), must have overnight supervision for minimum 24 hours.
I would love to her what other units do

[girlsptz]

nurses give the conscious sedation....Versed or Diazemuls for Gastro's and Fentanyl and Diazemuls for the Colon's. The patients are discharged 1 hour after they return to our recovery unit from their test and are stable. They have to had previously arranged a responsible adult that will drive them home. They are instructed that it is illegal to drive for the next 24 hours. It is very rare that anyone has to stay pass this 1 hour window.

Sandra

[JEEMA]

In the middle east (where I used to work), patients are usually sent home at the end of the day. We used to give them the antidote just to keep them awake and be ready for discharge. It was only when we experienced a complication after a colleague give two antidotes, narcan and flumazenil at short intervals that we kept giving them at the minimum. Patient developed pulmonary edema after colonoscopy. She was fine after the procedure but started coughing frothy secretions after receiving the 2 antidotes.

It was late and we want to discharge the patient... but it turned out we have to stay longer than anticipated.

For out-patients who never respond to repeated doses of antidote, they are admitted for observation. Otherwise, those who have nobody to accompany them are advised to take a cab to reach home and come back in the evening to pick up their car.

I miss working in endoscopy...

[Lucy2]

The unit I work in (New Zealand) we give Midazolam and Fentanyl, we normally keep patients 30mins to an hour after the procedure they must have someone to take them home and are not allowed to drive for 24 hours.

[Kyli]

I work in Australia. We use anaesthetists in our unit - whom administer propofol, midazolam and fentanyl.
Our outpatients are kept for at least an hour and a half and then discharged home. They have prearranged transport home, as they are not to drive until the next day.
The patient is also given a discharge pamphlet when they leave, with all the previously mentioned instructions such as not to drive, no alcohol for 24hrs, not to sign legal documents or make important decisions until the next day etc etc

[mshultz]

Originally Posted by MizLisa

Hello in the unit I work in in Southern California we can discharge pts after being in recovery for 1/2 and their vital signs are within a normal range of their baseline. We also require pts to pass the air from the colonoscopy and have a soft non tender abdomen and to be able to swallow without and pain or difficulty after an EGD. We use demerol and versed. Usually the average does is 50mg demerol 3-4 mg of versed per pt. That is the average. Sometimes less and sometimes more. We are also seeing a trend of pts (especially men) having a colonoscopy without and sedation. They leave after they pass the residual air from the procedure. A 24hr stay is excessive and versed is pretty much metabolized in about 20 mins. Good Luck! Lisa

What techniques are used in order to make colonoscopy bearable without sedation? The techniques that I have read about include using a gastroenterologist with extensive experience and skill, the use of abdominal compression to prevent looping, and the Olympus Scopeguide, which transmits an image of its path through the colon, so that looping can be seen and prevented.

Your post is the most encouraging yet about colonoscopy without sedation, since you say that it is becoming more popular. I was initially given 50mg Demerol, and 1mg Versed, since I wanted to watch. I asked for more drugs, probably when the scope was going from the transverse colon to the ascending colon, and was given 25mg Demerol and 2mg Versed. Unfortunately, I was not able to remember the rest of the procedure.

When it is time for another colonoscopy, I will request it without sedation. This will probably mean going out of town, but as Ohio is blessed with top-notch medical facilities, I doubt that I will have to go all the way to California.

Michael E. Shultz
mshultz@valkyrie.net

"Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read."
Groucho Marx

[VivaLasViejas]

Undergoing a colonoscopy without sedation is something that I wouldn't ever want to try.......no thanks, give me plenty of Versed and Fentanyl, and I'll take a cab home if I have to!

Our outpatient surgery department generally allows people to go home within an hour of their procedures as long as they're able to drink, void, ambulate, and have a 'responsible adult' to drive them home. (Unless, of course, they keep dropping their 02 sats like I did after my recent surgery, in which case you have to stay put until you're above 90% on room air...... ) Patients also sign a paper explaining that they should not drive, operate machinery, make important decisions or sign legal papers for 24 hours after the procedure. (Yeah, I can just imagine driving the 20 miles to my attorney's office and having him draw up my living will with all those sedatives and a Percocet chaser swirling around in my bloodstream...... )

[traumaRUs]

If I'm the patient, more sedation is better, lol! However, it is amazing the different practices throughout the world. Thanks everyone.

[mshultz]

As far as the time frame for my colonoscopy:
The procedure took about 30 minutes, I was in the recovery room another 30 minutes, and was back in the hospital room for an hour before being released. I was given the discharge instructions as I previously posted in this thread, but did not have to sign them.

Michael E. Shultz
mshultz@valkyrie.net

"Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read."
Groucho Marx