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.

mindyg22 said:
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.

Specializes in OB, GI.

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!!

How considerate of the doctors to order more sedation (amnesiac) than analgesia.

Specializes in OB, GI.
CrohnieToo said:
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).

Specializes in Anesthesia.

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.

Specializes in OR, PACU, GI, med-surg, OB, school nursing.
alterego33 said:

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:

Quote
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.

alterego33 said:

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).

alterego33 said:
.....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?

Specializes in Anesthesia.

I stand corrected and thank you for pointing out the ASA standard. In my practice, I prefer verbal stimuli, because I find tactile stimuli to be related to where you stimulate the patient and have even seen bruising from deep stimulation. Also, one can keep talking to a patient, but cannot continue tactile stimulation.

Keep the good discourse coming. We all learn from it.

that is a very scary thought!! completly agree with the previous posting. every person is different, titrate!!

I found this thread when I searched for the recommended dose of med during endoscopies. I am a patient and have had two.

In the first one, some years ago, which was both a colonoscopy and endoscopy, I was fine afterwards, and the report said I had been given for the colonoscopy 3 mg Versed and 75 mg Demerol with an additional 25 mg Demerol. The endoscopy was afterwards and I had 2 mg of Versed.

Recently I had just an endoscopy by a different doctor and I was very wobbly when I left. When I got home, I realized that I must have fallen at some point, I assume during recovery, as my tailbone hurt and was black and blue. Also my back hurt near the spine if I moved in various directions. According to the report, I was given 10 mg of Versed and 100 mcg of Fentanyl.

So this is just a plea from a patient to watch over people in recovery so that they do not hurt themselves, and to not overmedicate.

And I could NEVER get past the curiosity! I would request a copy of the full reports AND nurses' notes.

NOT a wise idea to leave me visible souveniers like that w/o at least a casual mention of them. Pooh happens, some times strange "reactions" occur to various meds - but I'm gonna wanna know about them 'cause I "can" develop a suspicious mind when it is ignored by those who are "in the know".

I actually have the doctor's report, no mention of this, but I suspect it happened in recovery, so she may not know about it. I don't know that the nurses(?) do a separate report. I want to tread gently so as not offend anyone, but I will ask her at my next appointment.

DON'T ever be afraid to offend someone! It is your health and your body. Recently I had an upper scope, went fine but was not told what they were knocking me out with till I asked. Bad effects with the versed. Two weeks later had colonoscopy and it was a nightmare. 200 fen and 8 versed. Woke up crying in pain and NOTHING was done. I'm sure doc was counting on amnesia effect. Resulting pain sent me to ER where I got strong pain meds I had to take for nearly 2 days till I could heal up. I keep a current file of all my medical records and encourage others to do the same. You would be surprised how many errors are logged in your file. It also allows you to accurately tell medical personnel what did and did not work for you in what doses. If ANY doctor hurts you do not go back to them nor let them refer you to one of their friends!

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