Average doseage of conscious sedation while doing endoscopy's - page 8
by lmbv55 122,231 Views | 85 Comments
I am interested in the average dose of conscious sedation that Endo nurses are giving. We use demerol and versed at my hospital and feel that several of our doctors need more education on conscious sedation but have no numbers... Read More
- 0Aug 14, '08 by mgalloLPNQuote from CrohnieTooMindy, there is NOTHING painful about the upper endoscopy! NOTHING. IF you aren't "adequately sedated" the absolute WORST you will encounter is some strong gagging. And given the throat spray they use you might likely not even counter that or just mild gagging.
It is the lower scope, the colonoscopy, that CAN be painful if the scopist doesn't take his/her time and proceed slowly or gets too carried away w/the amount of air used to distend the colon to allow for easier passage of the scope.
AND! No nasty prep for the upper endoscopy!!! County your blessings! You're getting off easy w/just the endoscopy!! :lol:
THANKS!!! A TON!!!
- 0Oct 13, '08 by hjc3405I worked in a GI clinic for a few years (I just recently switched specialties) we used cs- (demerol and versed) we had 4 docs and the average between all of them was about 50 and 5. But they didn't start out with that much. Usually starting out with about 25 of demerol and 1-2 of versed. If more meds are needed during the procedure, versed is usually administered more frequently than demerol. That's not to say that we didn't have patients that used way less or way more!!
- 0Oct 13, '08 by hjc3405Quote from CrohnieTooThe versed seems to help the patient to become more relaxed--which helps the patient pass the air that gets put into the colon. If the colonoscopy because more discomfortable--such as a smaller person (which we use pedi scopes on) or someone that has a lot of scar tissue in the abdominal are--more demero is administered. We have also had several patients opt to have the colonoscopy done with NO sedation. Our docs don't recommend it, but it is done (we do go ahead and start an IV just in case sedation is needed during the procedure).How considerate of the doctors to order more sedation (amnesiac) than analgesia.
- 1Nov 6, '08 by alterego33This is the most frightening thread of this entire forum. Not ONE answer about the pharmacology of the sedative, opiate, ANESTHETIC agents being used. First, if one has to ask about average doses, you should NOT be administering any of these drugs. There is no average dose...it is patient dependent and MUST be individualized to patient condition, ASA physical status, other medications being taken, cardiovascular, respiratory, hepatic and renal status, body habitus, etc.
Do the patients a favor and hire a CRNA to do the sedation.
Also remember the term is CONSCIOUS sedation. The patient must be able to respond to verbal stimuli or else it is general anesthesia.
I know there will be an onslaught of people telling me how they have done thousands without a complication, etc, etc. Sorry, unless you can pass a verbal exam of the pharmacology of these medications and the physiology of the monitoring including the A-a ratio seen with pulse oximetry and evaluation of wave forms of end-tidal carbon dioxide monitoring, you have no credibility.
Expect new government standards on this and hopefully soon.
- 1Nov 7, '08 by Booty NurseQuote from alterego33Um, not exactly. Not according to the American Society of Anesthesiologists, anyway.Also remember the term is CONSCIOUS sedation. The patient must be able to respond to verbal stimuli or else it is general anesthesia.
From Practice Guidelines for Sedation and Analgesia by
Moderate Sedation/Analgesia (Conscious Sedation): a drug-induced depression of consciousness during which patients respond purposefully* to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.
Deep Sedation/Analgesia: a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully* following
repeated or painful stimulation. The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent
airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.
General Anesthesia: a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation.Quote from alterego33I much prefer doing endos with a CRNA providing MAC, and wish they were all with MAC. Propofol works great, the patients are more comfortable, and I know I have an expert in the room in case anything goes wrong (in my state, an RN can't give Propofol, which is fine with me). But hello.... RNs are not in charge of hiring! Payment for MACs is a huge issue, and with health care financing getting tighter, and CAPS and fospropofol waiting in the wings, I imagine that CRNAs will be in the rooms less, not more (not a good thing, in my opinion).Do the patients a favor and hire a CRNA to do the sedation.
Quote from alterego33Not sure what you mean here. To know the A-a ratio, you need to get arterial blood gases, which are not done for a routine colonoscopy/EGD. Care to elaborate?.....the physiology of the monitoring including the A-a ratio seen with pulse oximetry....
- 0Nov 7, '08 by alterego33I stand corrected and thank you for pointing out the ASA standard. In my practice, I prefer verbal stimuli, because I find tactile stimuli to be related to where you stimulate the patient and have even seen bruising from deep stimulation. Also, one can keep talking to a patient, but cannot continue tactile stimulation.
Keep the good discourse coming. We all learn from it.