Average doseage of conscious sedation while doing endoscopy's

swmn · Dec 11, 2001

I have noticed in elderly patients onset times are delayed compared to younger patients. I don't have any firm rules yet about when to switch from doses at 2 minute intervals to 3 or even 5 minute intervals, but I do have some guidelines. Anyone over 80 yo, 3 minute intervals is as fast as I will push. 3 minutes goes for lots of folks in their 70s too.

60s is kind of borderline, I guess mostly I am guessing how much longer this patient is going to be coming in for elective procedures.

I have noticed redheads tend to have delayed onset times earlier than brunettes, so redheads over 70 I treat like brunettes over 80. Seems to work OK.

There are a couple other groups I take my time with. I don't see very many, but every once in a while I get to sedate a Basque. I am not going to say they have "funny" names, just unfamiliar combinations of letters in their family names, and it seems to take a little longer for whatever dose I give them to reach peak. Really nice people too, usually. Another one is patients over 100 years old. The few I have seen coming in for elective procedures usually look better than my dad, and he is only 58. Centurions generally tolerate meds pretty well, but I conciously use 5 minute intervals when sedating them just because they have come so far I wouldn't want to be "the one".

TeresaLRN · May 7, 2002

Our GI doc does a very nice job of keeping pt. comfortable with 60mg of demeral and 2-4mg of versed for colonoscopies and 50mg demerol and 2mg versed for EGD. Of course the dose varies with pt. age and size. We have a surgeon that uses the fentanyl and I don't like it as well as the demerol. The surgeon has gotten better at medicating. There were times I was giving 300mcg of fentanyl and 8mg versed to the same person!!! Docs need to allow the meds to kick in before rushing to start the procedure. The pt. are more comfortable.

carol a smith · May 11, 2002

average in our dept is probably demerol 100-125mg with versed 2-5mg. have give up to 175mg with versed 7 mg once.

NurseDennie, BSN, RN · May 12, 2002

OMG I wish I hadn't read THIS thread!!!! Pmenrs's post has scared me to death! I've got to have one done next week sometime, and I'm fat, too!!!!

I'm fat, but I should be fairly easy to put under. I want to be completely snowed now!!

Love

Dennie

NurseDennie, BSN, RN · May 12, 2002

Eeeeek - I just read swmn's post. I'm redhead, too!!

I think I need some Versed NOW!!

Love

Dennie

formernurse · May 24, 2002

I have had 4 colonoscopies in the last 4 years, and can only remember one time when I felt a fair amount of discomfort. Thankfully, my GI doctor is a very caring and compassionate lady who takes her time and listens to my concerns. Am very sorry to hear that you had so much pain with your scope. Be sure and let you doctor know that you were displeased. I recently had surgery under local anesthesia with hypnosis, and that worked beautifully. This week I had a root canal and used hypnosis alone. That. too, was a complete success. The next time I am scheduled for a c-scope, I'll also use hypnosis. Don't give up on having scopes--they can save your life by screening for colon cancer.:) :)

Classy · Feb 8, 2004

On Thursday, I had an EGD which was extremely uncomfortable. I've had them done prior to this without a problem using Demerol and Versed. Last fall, I had a colonoscopy where they didn't feel that I was sedated enough because I was wide awake even with a very high dose of Versed. I was comfortable for the endoscopy the entire time. A few weeks after that procedure, they did an ERCP under general anesthesia based on their concern about the inability to get me fully sedated for the colonoscopy previously.

I mentioned the above incidents to the sedation nurse and told her that I believed I would need a high dose of Versed for this procedure. The sedation nurse insisted on using Fentanyl and Droperidol only instead. She claimed that the Droperidol would make me very sleepy so I wouldn't feel anything. Even though I was very drowsy during the procedure, I felt and remembered everything. It was a horrible experience! I couldn't talk due to the mouth guard but was moaning and gagging uncontrollably the entire time. I felt every movement of the endoscope also which was very uncomfortable and somewhat painful. I didn't know how to get them to stop. Afterward, the sedation nurse claimed that I was so uncomfortable because I had an overactive gag reflex. But I don't ever remember gagging in the past during my previous 4 EGD's. Despite being so uncomfortable during the procedure, I was much more sleepy afterward this time which I assume was from the Droperidol. I couldn't seem to wake up and slept for the next 12 hours straight. In the past, I felt awake and really good almost immediately afterward.

I haven't discussed this incident with my doctor yet. I was still very sleepy yet when he talked to me on Thursday. I have an appointment with him in 2 weeks where I plan to discuss it.

Since I have Barrett's Esophagus, I know I need surveillance frequencies on a regular basis. But I am now dreading having this done ever again. I'm also a rape survivor with PTSD. Prior to this EGD, my PTSD was very well controlled. Since the EGD, I've been crying uncontrollably and having numerous flashbacks again. This EGD experience felt very much like getting raped all over again. I believe it has resulted in me being retraumatized.

I also see that someone mentioned that antidepressants may affect sedation. I am on strong antidepressents due to Severe Major Depressive Disorder which I just received Medical Disability Retirement for. I'm on Lamictal, Wellbutrin, Synthroid, Zyrtec, Vitamin D and Nexium. I've recently been taken off of Reglan by my doctor and psychiatrist due to the depression and suicidal ideation side effects.

In your experience is using only Fentanyl and Droperidol an adequate sedation for most people with EGD? Is that as effective as Versed and Demerol for conscious sedation? Do you know if any of these medications are contraindicated for severe depression?

Thanks for reading my long letter,

Classy

robrn · Feb 8, 2004

We use propofol for sedation and our MD's guarantee a painless procedure. To this date we have had no complaints, from our patients. We start with 30 to 50 milligrams of propofol then give incremental doses of 10 to 20 milligrams depending on the patient's response. Propofol is very predictable fast acting and rapidly dissipating. I have found Versed and Fentynl doses are all over the map, depending on the patient's previous exposure to benzos and narcotics.

mshultz · Feb 8, 2004

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.

Classy · Feb 8, 2004

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

Classy · Feb 8, 2004

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

mshultz · Feb 8, 2004

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.