Average doseage of conscious sedation while doing endoscopy's
- 0May 27, '01 by lmbv55I 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 to get an average dose of medicaiton. Any info is appreciated.
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- 0May 28, '01 by EndoRNThere is absolutely no "average" dose. Some 300 lb. man may take only 25 of Demerol and maybe 1-2 of Versed whereas some tiny little old lady may take 150 and 7!
Where I work we are all required to be certified in IVCS. I don't think anyone should be pushing these meds that is not! I would definitely recommend you and your staff looking into getting educated!
Picking an "average" dose and pushing it is a VERY scary thought!!
[ May 28, 2001: Message edited by: EndoRN ]
- 0May 28, '01 by GInurseI work for a gastroenterologist and assist with endoscopy daily. I am the one who administers the conscious sedation and I determine how much medication is enough. He has given me that responsibility. While I do agree with the above post, there IS an average dose. We give Demerol and Versed as well, and also use Benadryl for added sedation if necessary.
We always draw up 50mg of Demerol and 5mg of Versed to start. I start sedation with all 50 mg of the Demerol, unless the patient is very elderly, or otherwise compromised, and 1 mg of Versed. For younger people or very anxious people, I usually start with 2 mg of Versed.
I would say an average dose of Demerol is 50 mg and an average dose of Versed is 3-5 mg. However, we have used up to 150 mg of Demerol, and 15 mg of Versed - especially during ERCP's.
One of our partners uses about 30 mg of Versed during his Endo-cinch procedures.
Hope this helps to answer your questions.
P.S. Are you a member of SGNA???
- 0Jun 19, '01 by prmenrsI had this proceedure done to me yesterday. I haven't had that much pain since I had appendicitis! I was told I got 100 of Demoerol and 5 of versed, but I'm here to tell you IT DIDN'T WORK!! I remember everything, including saying ouch continuously throughout the fun and asking them to stop at least twice.
Can anyone explain why they didn't stop and get the pain under control?
When I asked later why it hurt so much the doc mumbled something about me being "too fat"! (I am fat, but I don't believe that's why it hurt so bad, and if that's really the case, why wasn't I warned ahead of time?)
It's been >24hours, and everytime I think about this, I start crying.
Any insight you can provide would be appreciated. Thanks
- 0Jun 24, '01 by EndoRNprmenrs,
That sucks! I'm so sorry that happened to you. I work at an outpatient surgery center now, doing GI. We have anesthesia there so I don't have to do my own sedation anymore. It's wonderful!
But what happened to you really isn't the norm with IV conscious sedation! We would experience someone from time to time that we had that problem with, but 90% of the time we were able to keep people very comfortable. 100 and 5 is a pretty decent dose, but some people do require more than that to keep them comfortable! And, supposedly, the more people weigh, the more of the meds they do need. But, honestly, in my experience, it seems to make no difference whatsoever. I've see "fat" people get totally snowed on small doses and vice versa. It's all so individualized.
You may also have had a real long and twisty colon which is sometimes harder to get through and more uncomfortable.
Nevertheless, I am sorry you were so uncomfortable. Next time you have this done, maybe your doctor will have it done by anesthesia vs. IVCS.
And please don't think "there will be no next time" because this test is SO important. I have learned so much about the importance of colon CA screening since going into GI a few years ago!
- 0Jun 25, '01 by prmenrsThanks for responding! I am on antidepressants, and my psych told me that could have affected how the drugs were metabolized and how I felt afterward. That helped a lot! Maybe for pts like me who are on more than a couple of meds, a pharmacist should review the profile and advise. I'm going to make that suggestion.
Again, Thank you for your help. It will be a long time before I do this again, even though I realize the importance!
- 0Jun 25, '01 by endomargeOriginally posted by endomarge
If the doctor is rough, and is a hurry he may order more medication than is needed....we have the right to refuse depending on the vital signs.....we have one doctor that is so gentle his patients usually are medicated with fentanly 50 mcg and 1 mg of Versed!!!!!!!!!!!!!! WE have one doctor that is extremely rough and his patients for an EGD someitmes if vital sign are stable will order 100 mcg of Fentanly to 6 mg of Versed In our Endoscopy unit a RN gives all the meds and the other RN or tech assists the physician Our Endoscopy record covers all aspects: pre procedure, during the procedure and post procedure. re@ patient LOC, discomfort during the procedure....The patient is recovered in the endo dept and discharged to an adult with discharge instructions
- 0Jun 26, '01 by endoshirleyI work at a large university hospital. We use Demerol, Fentanyl, Versed, and Inapsine or Benadryl. For some reason, the patients are being told they will be "knocked out" and so they expect to be totally asleep. It takes a few more minutes of teaching time to straighten that out. My average dose that I think works well on most people, including the healthy elderly, is 75 of Dem or Fent, plus 3 of Versed, plus up to 2.5mg of Inapsine. This seems to provide a very good amnestic effect, and yes, the patients are discharged under their own power. Our docs are starting a study on the efficacy of Benadryl, as there has only been anecdotal reports about its effectiveness. I agree with EndoMarge that a doc's experience and gentleness make all the difference in the world when it comes to how much sedation a patient needs for the average colon or egd. But for procedures like ERCP and EUS, when it is important to keep the patient still, sometimes you have to give alot more than you expected. By the way, we do a fair amount of our ERCPs under GA; I mean at least it's not a big deal to get it scheduled, etc. Also, we have our own fluoroscope (C-arm) so we don't have to hassle with the xray dept at all.
- 1Sep 8, '01 by tamdsandlinI used to be a GI nurse and I worked with a specialists. I am also very sorry that you had a bad experience with your c-scope. Most of the time patients say that the prep the night before was worse than the actual scope! Everyone is different though and it is an uncomfortable procedure. Just making an appointment @ a GI office is enough to make you uncomfortable! Please don't let this experience keep you from doing it again. If they took any biopsies, in about a week the results will be back. If you had any polyps, it is VERY important to have this test done again anywhere from 1-5 yrs. (depending on type of polyp). Choose another GI Doc next time or schedule an appointment (or @ your follow up appt.) to tell you Doc how uncomfortable you were and maybe next time he'll know how your body responds to the meds better. I would personally think it would be easier to stick with the same Dr. because you won't be as nervous next time and with your records etc... If any doctor called me "fat," and did'nt adjust my meds because of that, I think I would take my business somewhere else. Hope everything goes well.