Average doseage of conscious sedation while doing endoscopy's

Specialties Gastroenterology

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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 to get an average dose of medicaiton. Any info is appreciated.

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.

TMnurse said:
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.

prmenrs said:
Thanks 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!

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?

Specializes in O.R., Endo, Med-Surge, Mgtmt., Psyche.

[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).

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.

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.

Surreal_44 said:
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/html/board/index.php/action=displaythread&forum=boweldisorders&id=12&realm=default

Why Colonoscopy Is More Difficult In Women

http://www.e-health-questions.info/html/board/index.php/action=displaythread&forum=boweldisorders&id=13&realm=default

Good luck and God bless.

CrohnieToo said:
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/html/board/index.php/action=displaythread&forum=boweldisorders&id=12&realm=default

Why Colonoscopy Is More Difficult In Women

http://www.e-health-questions.info/html/board/index.php/action=displaythread&forum=boweldisorders&id=13&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

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?).

bbarbie1 said:
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.

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!

cateccrn said:
...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.

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