Average doseage of conscious sedation while doing endoscopy's

Classy:

Did the doctor use a local anesthetic for your EGD? When I had this procedure, I was given a reduced dose of sedation (probably demerol and versed) due to my condition (I had lost about 4 units of blood) and a spray anesthetic. The sedation did not affect me, so my memory of the procedure is sharp. It was quite tolerable, with no pain or gagging. Near the end of the procedure, I tried to keep from coughing, but was told to cough. I thought at the time that this was due to the fact that when I was told to gargle with the local anesthetic, I promptly choked and had to swallow. I think now that the doctor was checking to see if I could protect my airway.

As far as a gag reflex, the insertion of the nasogastric tube in the ED was unpleasant, and its removal before the EGD unpleasant, but less so. I did not have any trouble with gagging, however.

I did receive the spray anesthetic in the back of my throat with this EGD just like I have in all my previous EGDs. I know at least one of my previous EGD's, I was viewing the screen and understood what they were saying but don't remember any discomfort during the procedures. If that would have been the case this time, I wouldn't have had a problem with the procedure because I find it very interesting to view the monitors.

I'm almost positive that I was not given Versed or Demerol at any time during this recent EGD. I'm thinking that maybe this sedation would have been more effective if I had been given the sedation earlier. She combined the medications and placed them in my IV as the doctor entered the room. They proceeded with the spraying of the throat, mouth guard placement and then the EGD immediately.

How long would it take for the Fentanyl and Droperidol sedation to take effect? It is likely that my discomfort was due to the fact that it wasn't given enough time to sedate me? Do you think I should talk to anyone besides my doctor about what happened?

Becky

Michael,
I saw a post from you in another thread stating that you generally do dental procedures with analgesic. That is the case with me also. In fact, I'm currently 45 years old and have never had Novacaine or any other analgesic during a dental procedure. During the dental procedures where I questioned the saneness of that decision, I realized that the pitch of the drill was more bothersome than actual pain so I doubt that Novacaine would have helped me.

The reason I am discussing that in this forum is because I don't want people to believe that I am a whimp who can't tolerate a little pain and being uncomfortable. I have done that numerous times with other procedures where the doctors couldn't believe my level of tolerance. For this to be that untolerable to me, I know that most people wouldn't have been able to tolerate what I just did.

Becky

Classy:

I would never consider someone who is complaining about gagging during a procedure as a wimp. Gagging, along with nausea and vomiting, are all quite unpleasant.

As I said in another thread, my willingness to endure pain turned out to be a mixed blessing. Since I could not see the duodenal ulcer, I assumed that since the pain did not affect my work or school, then the problem was not that serious.

Prmenrs,
I am so sorry about your experience. Let me just tell you the pain was not because you are "too fat" (that doctor ought to be shot for saying that). I am overweight also and I had a colon dec 2002. I had 2 mg versed and watched the whole thing, I really didn't feel much pain at all (my husband. who is not overweight, also had one and said the same thing). Everyone's pain perception is different. The doctor should have gotten your pain under control before continuing. I work as a sedation nurse and if my patient is experiencing pain and is awake, I will say something to the doctor. I have had paients that have had pain, but would doze between times of pushing the scope. They usually don't remember anything. I have had patients that moan the whole time and don't remember then a few times ones that remember everything. Some people are more susceptable to the medication, and some aren't. I've had some patients that the demerol has made them aggitated. As I said everyone is different. If you have to have another colon, I'd get another doctor.
Bj

I just had a colonoscopy last week and they used Diprovan for the sedation. Don't know the amount but I will tell you I was out in a second and woke up feeling great!!!! Oh...CRNA administered the Diprovan.

I am an operating room nurse with over 25 years experience, and I do not feel that OR nurses--or endo nurses--should be giving conscious sedation, and definitely NEVER propofol. All the "training"--inservices, rather--they can give us in the world does not equate to the training any CRNA or anesthesiologist has, particularly in airway management, and the fact is that we are not trained to handle one level deeper than conscious sedation--that is, general anesthesia.


Check out the ongoing thread of mine in the CRNA section entitled "OR Nurses Giving Conscious Sedation--Why Should We?" I would welcome your comments.


Also, if you have no other objections to putting your license on the line, think about it--they just don't pay us enough to do a CRNA's or anesthesiologist's job.

An article follows for your general interest. As usual it, took a patient death to effect change to an ongoing dangerous practice.


FYI on Propofol Administration by RNs


Saying that it has received several reports of adverse events, including
the death of a cosmetic surgery patient, after RNs improperly
administered propofol, the American Association for Accreditation of
Ambulatory Surgery Facilities (AAAASF) is rushing to ensure that only
those trained to give general anesthesia or rescue from general
anesthesia administer propofol in its 1,100 or so accredited facilities.
The AAAASF announced last week that facilities that want to continue to
use propofol -- even if only for "conscious sedation" -- must either
upgrade to a Class C facility (where all anesthesia must be administered
by an anesthesiologist or CRNA) or promise to always use an anesthesia
professional to administer the drug. Facilities must comply by May 1.

"We decided that we need to get our standards in line with the
manufacturer's recommendations," says Jeff Pearcy, executive director of
the AAAASF. "The easiest way to do that was to require those facilities
that want to continue to use propofol to become Class C facilities."

For Class B facilities that would like to continue to use propofol but
won't use other types of general anesthesia, complying with the new
standard is simple. These facilities must fill out a form certifying
that they have a dedicated anesthesiologist or CRNA administering the
sedative-hypnotic. They also must have neuromuscular blocking agents
available in the facility. No on-site inspection is necessary. There
will be no additional charge, says AAAASF.

Those facilities that are upgrading to a C and plan to use general
anesthesia (inhalational) in addition to using propofol must comply with
all Class C criteria, says AAAASF.

AAAASF President Michael F. McGuire, MD, a board-certified plastic
surgeon, says the major motivation for making the change was that
"administration of propofol by a non-anesthesia provider is really not
appropriate."

Dr. McGuire adds that the new standard has caused quite a bit of
confusion and concern, mostly among Class B facilities that don't give
inhalational anesthesia and misread the standard to mean they couldn't
administer propofol unless they bought an anesthesia machine and CO2
monitor. Part of the confusion, he says, lies in the nature of the
propofol.

"Is propofol a general anesthetic or a sedation agent? It's both.
Really, truly, it is both," says Dr. McGuire. "At a certain level and in
a certain individual, it is a sedation agent. In other individuals or at
higher does, it becomes a general anesthetic agent. It's so
unpredictable, which is not a problem if you're an anesthesiologist but
can be if you're a surgeon trying to do surgery and supervise a nurse
giving the medication."
__________________

I'm going with Stevie on this one.

As a RN/NP (ACNP/FNP) I am 100% about showing what nurses can do.
However, giving CS is not one of them, unless you're a NP or CRNA. Some people will even exclude NP from that list.

Some of the doseages listed in this thread are not quite right. They seem very, very light on the sedation, and others a bit heavy handed.

I am sure that every one of you practices the absolute best nursing you can. I would just prefer that this be left to those with a little bit more training.

-Dave, who wears a flame retardant suit... so don't bother

I had mine done MOnday (this week) and was totally terrified going in. Totally. It seems I found a wonderful doc, very reassuring, very gentle, and had no pain except a couple cramps. 100 mg demerol, 10 mg versed. I am convinced the doc makes a huge difference. I'd waste no time finding a new one for next time. I'd drive hours to another state if I had to. There's no point in trying to reason with one that doesn't understand or doesn't care. Or is pressured to stick to a time schedule, so he has to move quickly and is rough. Ask around to find out who had a good experience and start there. Word of mouth is a good way to find a decent doc. You will pay enough for the services, you may as well have a good outcome! Take care! Good luck!

bbarbie1:

I am glad to hear that your colonoscopy experience was so tolerable. Can I also infer from the upbeat tone of your posting that no problems were found during the examination?