Average doseage of conscious sedation while doing endoscopy's - page 4

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... Read More

  1. Visit  SuperSGirl profile page
    0
    [color=olive]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).
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  3. Visit  Surreal_44 profile page
    0
    I had a quick question. I'm allergic to nearly every kind of medication, and I was also sexually abused as a child. Can a colonoscopy be done without using versed or some other amnesiac drug? I'm more afraid of NOT remembering what happened than I am of pain.
  4. Visit  kathyann profile page
    0
    May I ask how reimbursement is on procedures that have an anesthetist present?
    We have a physician that wants anesthesia for every case, but we are concerned about reimbursement.
  5. Visit  CrohnieToo profile page
    0
    Quote from Surreal_44
    I had a quick question. I'm allergic to nearly every kind of medication, and I was also sexually abused as a child. Can a colonoscopy be done without using versed or some other amnesiac drug? I'm more afraid of NOT remembering what happened than I am of pain.
    Yes, it can be done. It is best done w/some form of analgesia. I have my scopes (at my insistence) with just Demerol and occasionally a little phenergan when we get to the proximal transverse colon/hepatic flexure if the vagus nerve gets ticked off. Much depends on the skill and the patience of the person doing the scope. Not only am I awake and aware during the procedure and watching the monitor I bring my video cam and we videotape the monitor (I have a real jewel of a gastro!!). Be aware that I have a healthy colon. I'm not at all sure if one has UC or some type of rectal involvement that a scope w/o sedation/anesthesia could be safely done.

    You should find the following two articles of interest prior to discussing this with your gastro.

    A Study of Pain During Colonoscopy

    http://www.e-health-questions.info/h...&realm=default

    Why Colonoscopy Is More Difficult In Women

    http://www.e-health-questions.info/h...&realm=default

    Good luck and God bless.
  6. Visit  mshultz profile page
    0
    Quote from CrohnieToo
    Yes, it can be done. It is best done w/some form of analgesia. I have my scopes (at my insistence) with just Demerol and occasionally a little phenergan when we get to the proximal transverse colon/hepatic flexure if the vagus nerve gets ticked off. Much depends on the skill and the patience of the person doing the scope. Not only am I awake and aware during the procedure and watching the monitor I bring my video cam and we videotape the monitor (I have a real jewel of a gastro!!). Be aware that I have a healthy colon. I'm not at all sure if one has UC or some type of rectal involvement that a scope w/o sedation/anesthesia could be safely done.

    You should find the following two articles of interest prior to discussing this with your gastro.

    A Study of Pain During Colonoscopy

    http://www.e-health-questions.info/h...&realm=default

    Why Colonoscopy Is More Difficult In Women

    http://www.e-health-questions.info/h...&realm=default

    Good luck and God bless.
    I really appreciate your informative posts. You and another poster mention having bad reactions to Versed (referring to your first link). Although I have searched this site for days, I can not find the post I want. Anyway, as I recall, the poster explained that since Versed has no analgesic properties and reduces inhibitions, abusive behavior is to be expected when there is inadequate pain relief. Maybe one of the CRNAs or AAs will see this post and respond.

    Michael

    "Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read."
    Groucho Marx
  7. Visit  bbarbie1 profile page
    0
    I would love to know why versed is necessary for a colonoscopy. Why isn't a pain killer (i.e. demerol) enough on it's own? The implication is there is something we must forget (pain?).
  8. Visit  mshultz profile page
    0
    Quote from bbarbie1
    I would love to know why versed is necessary for a colonoscopy. Why isn't a pain killer (i.e. demerol) enough on it's own? The implication is there is something we must forget (pain?).
    It is assumed that patients do not want to remember the procedure. This was even the case for childbirth at one time. Since the pain cannot always be safely controlled with Demerol or Fentanyl, another assumption is that it is not pain if you do not remember it. I disagree with both assumptions. Versed is also used to control anxiety, although for me and many others, the creepy amnesia takes effect before any reduction in anxiety is noticed.
    Last edit by mshultz on Jul 17, '06 : Reason: Wrote "Versed" when I meant "Fentanyl"
  9. Visit  steelydanfan profile page
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    I had to BEG my husband to have his 50th birthday colonoscopy, and I am so grateful he had a great anesthesiologist who could use Diprovan!
    He does'nt remember a thing!
    But to say, CS can work well too, but often times the docs won't wait for the assessment part of titration, and sometimes you just need to tell the doc to hold on!
    I had a doc try to tell me that he could do an Endo without ANY sedation because it was SOO quick. Needless to say, I found another doctor!
  10. Visit  mshultz profile page
    0
    Quote from cateccrn
    ...I had a doc try to tell me that he could do an Endo without ANY sedation because it was SOO quick. Needless to say, I found another doctor!
    I assume this was for an upper endoscopy. According to my 15th edition of Harrison's Internal Medicine, upper endoscopies are routinely performed in Europe without sedation.

    I remember my EGD because the reduced amount of sedation (2 mg Versed + 50 mg Demerol; I was in the CCU) did not affect me. The procedure included Cetacaine throat spray and was quite tolerable, although my tolerance for this may be above average. I have read about upper endoscopies being done without the throat spray, but would never agree to that. If I were to have another EGD, I would refuse sedation.
  11. Visit  CrohnieToo profile page
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    I have my EGDs w/o sedation/analgesia except for the throat spray at my insistence. The only difficult part is the gagging. There is no pain. The gagging is no fun but watching the monitor and seeing for myself makes up for it.
  12. Visit  needlephobia profile page
    0
    I'm new here, about to have en endo and a colo same day for the first time. Problem is I've been taking versed (oral) 15 mg to sleep every night for the last 5 years (where I live is legal and I do have an rx). Would it be better skip this kind of sedation and go directly to propofol?
    thanks
    Mo
  13. Visit  CrohnieToo profile page
    0
    Quote from mshultz
    I really appreciate your informative posts. You and another poster mention having bad reactions to Versed (referring to your first link). Although I have searched this site for days, I can not find the post I want. Anyway, as I recall, the poster explained that since Versed has no analgesic properties and reduces inhibitions, abusive behavior is to be expected when there is inadequate pain relief. Maybe one of the CRNAs or AAs will see this post and respond.

    Michael

    "Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read."
    Groucho Marx
    Thank you, Michael. I've only related my own experiences which is limited as I don't work an Endo department. And so much relies upon the gastro or doctor doing the scope and if they are willing to take the time to advance the scope slowly and sensitive to scope looping. We have a gastro and a colorectal who like to race to see who gets thru their procedures fastest.
  14. Visit  monkeelouise profile page
    0
    I read through all of the replies on this site. I am an old endo murse, 10 years, I have sedated all types of patients. The endo lab I work in is hospital-base with inpatient and outpatient procedures. We handle all types of endo cases, except EUS.

    We are nurses, that these patients come to endo, put their trust in to care for them, sedate them, and protect their best interest as WE are the ones that put these patients in a VULNERABLE state.
    WE ARE THE PATIENT ADVOCATE! Speak up, Demand that the patient be sedated adequately and document those requests. MDs respond very well when they see your documentation and how it reflects upon them.

    Jewels:Benadryl 25 mg SIVP works wonders in assisting sedation for patients that take antidepressant meds, and are on a pain management program. These medications partially block the nerve receptor sites that Versed and Fentanyl or Demerol access. Therefore the meds don't work for these types of patients as effectivly as on others.
    There was some responses to a person being "fat", and not having enough sedation, and if memory serves, Demerol was used during the colon scope. We have seen that Demerol does not effectivly sedate someone with a large amount of adipose tissue, reponse to sedation is slowed, and recovery is longer. A 300 lb man that is mostly muscle will sedate quite faster and with less meds that a 300lb woman that is 5 ft tall. I am sorry for the this person's bad experience, I, personally, would find a different MD, and suggest GA for your next endoscope.
    There were many reponses that stated the patient pre-procedure was under the impression that they would be "knocked out". We have found that people ask friends and family about their endo experiences and well meaning nursing friends that are unfortunately uninformed about CS and come away with this very wrong expectation. PRE-PROCEDURE PATIENT TEACHING IS CRUCIAL! Take the extra 5 minutes to explain CS to your patient, what they may experience. Anxiety levels and patient complaints are reduced by that little something extra.

    These patients remember the extra time, smiles, and care that we give them. Their experience with their MD or endoscope may not be thought of fondly, but, they will return for another procedure based on the care WE give them.
    Okay, I'm off my soapbox for now, God bless.
    Last edit by monkeelouise on Sep 15, '07 : Reason: not finished,wrong key hit


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