Average doseage of conscious sedation while doing endoscopy's

No, there were no problems. I still would not do this on my day off, please don't misunderstand me. And I still don't understand why SCREENING procedures have to be so stress-inducing and invasive of one's person, but hey, it's done. And I'm not doing it again one second before 10 years is up!

I survived!! Thanks for your inquiry. Good health to you.

Hi,

I do conscious sedation for an endo lab, have done cardiac E/P requiring 360 J shocks previously and have had little problem with pt.s remembering. Docs need a better understanding of c/s, although lo and behold, a few trust our judgement. It has been my experience that more than a few docs don't know their patient. Example: a terminated ERCP. The patient rushed to RR for code due to VT. I pointed out that the patient had an implated defibrillator that was doing it's job overdrive pacing. The doc didn't know. Another example is a doc who was performing a colonoscopy and couldn't understand the anatomy he was seeing. I advised him that the patient had a history of partial colectomy, and had to read his H&P to convince the GE of the patient's history. He was viewing an anastomosis. These things make the nurse unpopular for pointing them out.

ASA score done correctly are a good index to start, meds regularly taken, and simply asking the patient their experience with painkillers and the like. Let them vent their anxieties, annswer questions, help them to feel at ease. I used to play Tai C'hi music in the background with low lights and soft verbal suggestion, as well as accupuncture point stimulation. It is controversial as to the power of suggestion, I think it works. I have probably put over 2000 people under sedation. That being the case, my gut helps a lot. I use the Ramsay scale and shoot for about a 4. This is an objective scale and has justified my practice on a few occasions.

Some will tell you that if they are on antidepressant/antianxiety drugs they require more painkiller. I have seen nurses just start pushing heavy doses on this class of patient. Wrong! Don't assume anything and start pushing. I usually give a test dose of 1-2 versed without the patient knowing, and observe results as I attend to other duties. Titrate to your desired level carefully and according to policy. I realize that the physician thinks they should be well sedated in 5 minutes or so, which is a violation of policy on most patients. Or they expect that one can just keep pushing drugs after they start the procedure. Getting through the sigmoid with an ill sedated patient is extremely painful, especially if a loop forms. Remember that extreme pain is just as dangerous as oversedation. Read the literature.

I prefer Fentanyl, less side effect, rapid response and recovery, more controllable, less instance of nausea. Why the docs are so hung up on Demerol, I don't know. If you read c/s literature, there is little or no mention of Demerol, fentanyl and MS being the preferred agents. You can't use MS in an endo setting due to the side effect of causing or exacerbating colon spacticity. When you have a patient with an MS implanted pump you have this dual problem of spacticity and delayed reaction where they are difficult to arouse post procedure when everything catches up.

IMHO, practitioners should be familiar with the Ramsay scale and utilize it to achieve optimal sedation without going beyond your constraints of how deep a nurse can take a patient.

There will always be the occasional patient that just won't go down for reasons beyond me, given that they were honest on their history form. So you do the best you can.

My 2 cents=====================snake

Whoa - you guys have scared me. I'm glad I'm not a doctor person! Yikes...makes my palms sweaty!

Anybody use Brevital Sodium at sub-induction doses?

I have heard Brevital "brief if used at all" is good for short operative stuff but the solution is not suppose to be used with or come in contact with rubber stoppers or parts of syringes treated with silicone... and that would pose a problem usless your using glass.. good luck finding a glass syringe. Maybe they still use them in Texas.

Ha! Well maybe us poor little cow-pokes might be able to rustle one up. However, I am curious as to why that is not discussed in the prescribing information or any literature that is currently available concerning Brevital. Perhaps you could lead me in the right direction on this.

A GI doc mentionrf that contraidication sometime ago to me. I confirmed it with a Nurses Drug Guide 1998. However, I spoke with one of our MDAs today. He mentioned that those concerns have since been ruled out (also not mentioned on Eli Lillys drug info). He did mention that the drug is asssociated with hiccups... as you know hiccups in a sedated patient are a wonderful combination for aspiration hence, it is not a drug of choice.

Perhaps we work in different environments. When I sedate a patient, it is not to the point where their protective reflexes are smashed, because that would be an anesthesia induction. I also have a crash cart and airway kit ready just in case. I ALWAYS premedicate with an antiemetic, and if they come in and JUST ate, I will either order a gastric lavage/NG tube or load them up, give them some Reglan, and wait for a while. But this stuff has such a short duration of action that I like to use it on things like reduction of joint dislocations, etc. They come out of it in just a few minutes and when they begin to emerge, I give them an analgesic for pain.

I had a similar problem with an upper GI endoscopy. I am on about 10 oral medications with 2 being antidepressants. My GI doctor told me he gave me a boatload of sedation but couldn't get me out. He is planning on giving me even more with my colonoscopy coming up in September.

I've been told that people who are on antidepressants generally have a higher tolerance and need higher dosages of sedation. Has that been your experience?

I always hate this question! There is no average dose. To have an average dose per se', you would have to make the assumption that ALL people are the same. The least I have ever given is 3mg of Versed and 50 of Demerol or 3 mg of Versed and 50 of Fentanyl. I have given combinations of Fentanyl, Demerol, and Versed, etc. Everybody should be treated individually. Treat the patient! If the vitals are stable and the patientis fighting, you aren't medicating enough. I gave one gentleman, 500 mcg of Fentanyl, 150 mg of Demerol, and 20 mg of Versed. Mission accomplished, cecum reached. Now he doesn't have to have another scope for 10 years which beats a Barium Enema. The guy was awake through the entire procedure but was comfortable. We currently use Fentanyl in combo with Versed in my area of practice for colonoscopy. We use Demerol in combo with Versed for EGD's because it relaxes the esophagus better. Patient's wake up faster with Fentanyl. We do not reverse patient's unless it is warranted (ie: sustained apnea, severe bradycardia or hypotension).