Average doseage of conscious sedation while doing endoscopy's - page 6

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  CrohnieToo profile page
    0
    I haven't kept up on it since my area of interest is the small intestine, but last I knew Givens was close to FDA approval for either a pill camera upper endoscopy or a pill camera colonoscopy and working on the other.

    The drawback is a PCE can't remove polyps, dilate strictures, cauterize bleeding, stretch the esophagus if needed, etc. But - the observations can determine whether any of the above procedures need to be done and certainly is a lot more pleasant than the scopes themselves. God bless Givens Imaging!!!
  2. Visit  nursebabygirl 08 profile page
    0
    Quote from Mersa59
    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

    sorry so long to get back to you... i'm sorry about your experince.. that's awfull. When i sedate pt's i go slow with the sedation allowing "more time" for the medicine to work. No med will work properly if not given enough time to work. Not talking about all docs, but some what to insert the scope RIGHT after the first dose of meds are given.That can be less than 30 secs! it's the sedating nurse's responsiblity to tell the doc "wait, i'm not ready yet".
  3. Visit  lpnstudentin2010 profile page
    0
    Quote from monkeelouise
    .....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.

    I agree. I has an EGD a few months ago and was a little freaked. This is due to the fact that I had never had that type of procedure before. I had only had surgery where I was totally out (GA).

    The pre-procedure nurse could tell that I was freaked. I mentioned surgery a few times, and at one point the nurse took my hand and explained to me how CS works and how it was different from GA. This time of explanation REALLY helped me a lot. I was a lot more calm after that.
  4. Visit  mgalloLPN profile page
    0
    I have to have an endoscopy due to possible Barrett's esophogus. I'm an LPN student and graduate in December. After reading some of these, I'm terrified. The doc told me that "he will give me a few margaritas and tequilla" in an IV and I won't feel or remember a thing from the procedure. After reading these, I'm not so sure I want to have the procedure done. I haven't had anything done since I was 5 and that was a broken jaw repair. I don't remember that but I don't want to remember this either!
  5. Visit  CrohnieToo profile page
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    Mindy, there is NOTHING painful about the upper endoscopy! NOTHING. IF you aren't "adequately sedated" the absolute WORST you will encounter is some strong gagging. And given the throat spray they use you might likely not even counter that or just mild gagging.

    It is the lower scope, the colonoscopy, that CAN be painful if the scopist doesn't take his/her time and proceed slowly or gets too carried away w/the amount of air used to distend the colon to allow for easier passage of the scope.

    AND! No nasty prep for the upper endoscopy!!! County your blessings! You're getting off easy w/just the endoscopy!! :lol:
  6. Visit  Mersa59 profile page
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    Mindy,
    ask for propofol, I did not feel a thing or remember anything with mine, it was the colonoscopy that I was not sedated enough for.
    mar
  7. Visit  mgalloLPN profile page
    0
    Quote from CrohnieToo
    Mindy, there is NOTHING painful about the upper endoscopy! NOTHING. IF you aren't "adequately sedated" the absolute WORST you will encounter is some strong gagging. And given the throat spray they use you might likely not even counter that or just mild gagging.

    It is the lower scope, the colonoscopy, that CAN be painful if the scopist doesn't take his/her time and proceed slowly or gets too carried away w/the amount of air used to distend the colon to allow for easier passage of the scope.

    AND! No nasty prep for the upper endoscopy!!! County your blessings! You're getting off easy w/just the endoscopy!! :lol:

    THANKS!!! A TON!!!
  8. Visit  lpnstudentin2010 profile page
    0
    Quote from mindyg22
    THANKS!!! A TON!!!

    Ya endoscopies are not bad. I was sedated for mine, only remember one little couple of secs, I raised my are to reach toward the tube and was out again.
  9. Visit  hjc3405 profile page
    0
    I worked in a GI clinic for a few years (I just recently switched specialties) we used cs- (demerol and versed) we had 4 docs and the average between all of them was about 50 and 5. But they didn't start out with that much. Usually starting out with about 25 of demerol and 1-2 of versed. If more meds are needed during the procedure, versed is usually administered more frequently than demerol. That's not to say that we didn't have patients that used way less or way more!!
  10. Visit  CrohnieToo profile page
    1
    How considerate of the doctors to order more sedation (amnesiac) than analgesia.
    neveragain likes this.
  11. Visit  hjc3405 profile page
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    Quote from CrohnieToo
    How considerate of the doctors to order more sedation (amnesiac) than analgesia.
    The versed seems to help the patient to become more relaxed--which helps the patient pass the air that gets put into the colon. If the colonoscopy because more discomfortable--such as a smaller person (which we use pedi scopes on) or someone that has a lot of scar tissue in the abdominal are--more demero is administered. We have also had several patients opt to have the colonoscopy done with NO sedation. Our docs don't recommend it, but it is done (we do go ahead and start an IV just in case sedation is needed during the procedure).
  12. Visit  alterego33 profile page
    1
    This is the most frightening thread of this entire forum. Not ONE answer about the pharmacology of the sedative, opiate, ANESTHETIC agents being used. First, if one has to ask about average doses, you should NOT be administering any of these drugs. There is no average dose...it is patient dependent and MUST be individualized to patient condition, ASA physical status, other medications being taken, cardiovascular, respiratory, hepatic and renal status, body habitus, etc.

    Do the patients a favor and hire a CRNA to do the sedation.

    Also remember the term is CONSCIOUS sedation. The patient must be able to respond to verbal stimuli or else it is general anesthesia.

    I know there will be an onslaught of people telling me how they have done thousands without a complication, etc, etc. Sorry, unless you can pass a verbal exam of the pharmacology of these medications and the physiology of the monitoring including the A-a ratio seen with pulse oximetry and evaluation of wave forms of end-tidal carbon dioxide monitoring, you have no credibility.

    Expect new government standards on this and hopefully soon.
    NRSKarenRN likes this.
  13. Visit  Booty Nurse profile page
    1
    Quote from alterego33
    Also remember the term is CONSCIOUS sedation. The patient must be able to respond to verbal stimuli or else it is general anesthesia.
    Um, not exactly. Not according to the American Society of Anesthesiologists, anyway.

    From Practice Guidelines for Sedation and Analgesia by
    Non-Anesthesiologists
    :

    Moderate Sedation/Analgesia (Conscious Sedation): a drug-induced depression of consciousness during which patients respond purposefully* to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained.

    Deep Sedation/Analgesia: a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully* following
    repeated or painful stimulation
    . The ability to independently maintain ventilatory function may be impaired. Patients may require assistance in maintaining a patent
    airway, and spontaneous ventilation may be inadequate. Cardiovascular function is usually maintained.

    General Anesthesia: a drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation.
    Quote from alterego33
    Do the patients a favor and hire a CRNA to do the sedation.
    I much prefer doing endos with a CRNA providing MAC, and wish they were all with MAC. Propofol works great, the patients are more comfortable, and I know I have an expert in the room in case anything goes wrong (in my state, an RN can't give Propofol, which is fine with me). But hello.... RNs are not in charge of hiring! Payment for MACs is a huge issue, and with health care financing getting tighter, and CAPS and fospropofol waiting in the wings, I imagine that CRNAs will be in the rooms less, not more (not a good thing, in my opinion).

    Quote from alterego33
    .....the physiology of the monitoring including the A-a ratio seen with pulse oximetry....
    Not sure what you mean here. To know the A-a ratio, you need to get arterial blood gases, which are not done for a routine colonoscopy/EGD. Care to elaborate?
    flightnurse2b likes this.

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