Average doseage of conscious sedation while doing endoscopy's - page 5

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  Mersa59 profile page
    0
    I know this article is old. However I need to comment.
    Droperidol is Inapsine, and Antipsychotic medication.
    we used it in the past for out of control patients. It is now black boxed, I thought, and no longer used in psychiatry. there have been deaths related to its use.
    It is a chemical restraint, not a drug that I would think should be used for an EGD or colonoscopy. I was appalled to read this..
    I am an R.N. also.
    Mersa
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  3. Visit  Mersa59 profile page
    0
    Quote from robrn
    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.
    I had Prpofol, while it was great for my EGD, I felt absolutely nothing, I was totaly out. For my Colonoscopy , immediately after the EGD it was not what I expected. I was told I would feel nothing and be out.
    I felt the insertion of the colonscope, and every push for ward of that scope around the bends.
    I had pain, was moaning and remember moaning and yelling out Owe !!Owe!! Owe!! I also felt the removal of the scope.
    and had alot of discomfort and pain for a week -10 days after ward. I felt like a horse had kicked me. I have had C-sections and little pain meds after ward. a dislocated shoulder and so on. I am not a wimp to pain....but the propofol did not sedate me well enough for the colonoscopy, and I was angry as my thinking was that I had been lied too.
    the nursing staff were very accomidating, but again , I felt like I had been lied to about this, as I asked many questions and stated my knowledge of the proceedure and what others had told me they experienced.
    so while Propofol is better it is not something that sedates enough to keep you totaly unaware of pain, discomfort and what is going on.
    mersa
  4. Visit  CrohnieToo profile page
    0
    Well said, Monkeelouise!

    Mersa, it may well have been that you are one who doesn't respond as well and as quickly to propofol or may need a "heavier" dose for you size than many. It may well have been the person administering it was cautious due to you vitals or even that it would have been better had the EGD been done first before the colonoscopy. For sure, your doctor doing the scope was neither particularly skilled or conscientious of his/her patients or you would not have experienced the lingering discomfort after the procedure. The ONLY time I ever felt that "kicked in the stomach" feeling after a colonoscopy was my first scope when I reacted to the Versed and got agitated and hostile resulting in an incomplete as my gastro had to w/draw the scope w/nurses holding me down and a barium enema series the following day in the scope's stead.
  5. Visit  Mersa59 profile page
    0
    cHRONIETOO
    the egd was done first. I felt nothing , I was totaly out...had propofol for that..........however ....when it was time for the colonoscopy, which was "after" the egd.....I woke up, and woke up several times thru out the proceedure as I mentioned.
    so if I was sedated enough for the egd, I should have been sedated enough for the colonoscopy. They lightened up on the dose of propofol for the colonoscopy was my guess.my VS were ok thru out.
    Mersa
  6. Visit  CrohnieToo profile page
    1
    Propofol is a SHORT ACTING general anesthetic. It is NOT "conscious sedation".
    Propofol dosing and titration is variable, based on the patient's tolerance to the drug. Profound changes can occur rapidly. A patient can go from breathing normally to a full respiratory arrest in seconds, even at low doses, without warning from typical assessment parameters. There is no reversal agent. Unlike other sedation agents such as Versed there is no reversal agent for propofol. Adverse effects must be treated until the drug is metabolized.

    EGD is usually done before colonoscopy. All I was suggesting was that perhaps the results for you would have been better had the colonoscopy been done first. There is no pain w/the usual EDG just bad gagging. I've had both scopes done w/o "sedation" at my insistence.
    nursebabygirl 08 likes this.
  7. Visit  Mersa59 profile page
    0
    No thanks, I did not want to feel anything with either scope. If i would have had bad gagging, I would of done all I could to stop the proceedure.It is my understanding, now, that women have more discomfort with colonoscopy, and there is a higher chance of pain, when you have had abdominal surgery.. I had 3 C-sections in the past.
    so this may have contributed.
    However on many other sites, with patient accounts, many women, complain about the painful experience of colonoscopy. I would think this needs to be addressed better, and there needs to be better pain management.....that colonscope is huge,long, and the adult scope looks like a dern water hose.
    just my opinion and experience.
    Mersa
  8. Visit  Mersa59 profile page
    0
    CrohnieToo
    have you assisted in Push endoscopy?
    where they go as far into the small bowel as they can?
    What are you giving for sedation with that?
    I know they are doing more Pill Cam endoscopies now, as they say the Push endoscopy has more pain and discomfort with it, and there are higher risks involved secondary to the nature of the small bowel.
    more twist and turns, and it moves more easily when the scope is trying to be advanced.
    thanks for your input.
    Mersa
  9. Visit  nursebabygirl 08 profile page
    0
    Quote from Mersa59
    cHRONIETOO
    the egd was done first. I felt nothing , I was totaly out...had propofol for that..........however ....when it was time for the colonoscopy, which was "after" the egd.....I woke up, and woke up several times thru out the proceedure as I mentioned.
    so if I was sedated enough for the egd, I should have been sedated enough for the colonoscopy. They lightened up on the dose of propofol for the colonoscopy was my guess.my VS were ok thru out.
    Mersa

    Mersa were you ventilated during this procedure?
  10. Visit  nursebabygirl 08 profile page
    0
    Quote from Mersa59
    CrohnieToo
    have you assisted in Push endoscopy?
    where they go as far into the small bowel as they can?
    What are you giving for sedation with that?
    I know they are doing more Pill Cam endoscopies now, as they say the Push endoscopy has more pain and discomfort with it, and there are higher risks involved secondary to the nature of the small bowel.
    more twist and turns, and it moves more easily when the scope is trying to be advanced.
    thanks for your input.
    Mersa

    The problem with the sm bowel caps or pill cam as you call it is they can become lodged within the sm bowel, and if not passed the pt has to have surgery to remove!
  11. Visit  Mersa59 profile page
    0
    No, they had 0-2 there and a face mask and gave me some 0-2 while they were sedating me,I went out pretty quickly, did not wake up until the start of the colonoscopy. I was in and out during the colonoscopy.
    I would wake up and feeling pain, moan or call out and then would fall back to sleep, only to wake up moaning again, the time frame between wake up times I can not tell you. I do not remember all of it, I did not feel all of it. Or "remember" feeling all of it. there were several times that I was aware of pain, and more awake. in comparrison to other times.
    mersa
  12. Visit  Mersa59 profile page
    0
    we have given the pill cam to several patients on my unit no one had difficulty passing them. From what I read in the literature there is a very small percentage of patients who do not pass them, it was a miniscule amount. Like o.5 % or less.

    you did not answer me about the push endoscopy?
    mersa
  13. Visit  Mersa59 profile page
    0
    nurse baby girl 08,
    one of my other memories I have was while moaning in pain and calling out, I remember trying to sit up and one of the nurses, placing her hands on my shoulders, trying to get me to lie back down and saying shhhh shhhh....
    mersa
  14. Visit  CrohnieToo profile page
    0
    Givens Imaging who developed the pill camera endoscopy has also developed the Agile Patency Capsule. This is a dissolvable pill the same size as the PCE. You swallow the pill one day and 26 hours later they either "scan" your abdomen w/a hand held device developed by Givens or they do an abdominal xray. If the APC is still present you are NOT a candidate for the PCE. The APC will dissolve w/in 3-4 days.

    I first brought up the PCE w/my gastro before it was FDA approved in the hopes that I could get into a clinical trial. None were available at the time. I later realized I was not a particularly good candidate for it due to a high grade partial obstruction at my old resection site in the mid-ileum.

    Recently my gastro advised me they were now doing the PCE in my area and strongly suggested I agree to one. I reminded her about the partial obstruction and told her I would NOT agree to one w/o doing the APC first. She said the only place in our area using the APC was a 2 hour drive. But she later called and said she could get the APC thru one of our local hospitals. I jumped at the chance. Unfortunately, as suspected the APC didn't pass, there it sat big and bold as life at the partial obstruction site on abdominal xray. *sigh*


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