Nurses Pushing Propofol for Conscious Sedation -Your Thoughts? - pg.2 | allnurses

Nurses Pushing Propofol for Conscious Sedation -Your Thoughts? - page 2

I would be interested in getting feedback from GI nurses that are involved in propofol sedation in settings with and without anesthesia. Your thoughts and experiences please. Thank you, Randy... Read More

  1. Visit  wtbcrna profile page
    3
    Quote from laurentrilli
    You asked for opinions, I'm a med student (oldest in my class)..propofol is an induction anesthetic and should only be administered by anesthesiologists..nurses SHOULD NOT administer this drug. Personally, I would not be comfortable with a nurse (CRNA) doing my aneshtesia; I specify an MDA for safety. When I was a nurse, I thought that CRNA's did a great job; now that I have had a LOT more exposure I want an MDA doing my anesthesia, sedation etc..................
    Well I am glad that med school has totally brainwashed you.

    1. Propofol is a sedative, general anesthetic agent, & antiemetic.
    2. Since you know so much about propofol and are sure that only MDAs should administer it, can you tell me how many different formulations there are for propofol in the US? Which formulation(s) is safe for neonates, and which formulation(s) probably increases the severity of ARDS when used long term on ARDS patients?
    3. Instead of listening to the ASA and SDN propoganda why don't you actually quote some research that states that MDAs are safer than CRNAs.
    4. Have you ever been/completed CRNA school? That way you actually have some first hand knowledge of what you are talking about. I have trained med students during their anesthesia rotations on many occassions, and shared classes with med students. I also trained right beside MDA residents.
    5. Try reading some studies before making outrageous comments that have no merit. Feel free to dig up any that I missed. http://www.aana.com/Resources.aspx?id=666&terms=silber
    6. You obviously have no idea who delivers the vast majority of anesthesia in the US. I will give you clue it isn't MDAs. There isn't enough MDAs in the US to even come close to being able to delivering the amount of anesthesia needed in this country. A significant miniority of anesthesiologists don't even deliver anesthesia. They specialize in interventional pain management (a lot of time because it is very lucrative practice), become critical care specialists, specialize in regional anesthesia (and rarely set foot inside the OR) etc.
    7. Since we are stating opinions here: I would prefer a CRNA to do my anesthesia, and I will tell you why. CRNAs are trained to be systematic in their approach, to think outside the box when necessary, we give the majority of anesthesia, and we have been around longer as an organized profession. On the other hand anesthesiologists at most places rarely actually give anesthesia, they "supervise", MDAs in general are very sloppy, learn through trial and error what works best, and tend to be a lot more cavalier than most CRNAs.

    For everyone else's viewing pleasure see below:

    Pine Study in the AANA Journal
    [Pine, M, Holt, KD, Lou, YB. "Surgical Mortality and Type of Anesthesia Provider."
    AANA Journal. 2003;71:109-116.]






    In the April 2003 AANA Journal, Dr. Michael Pine, a board-certified cardiologist widely recognized for his expertise in analyzing clinical data to evaluate healthcare outcomes, and a team of researchers published the results of a groundbreaking study titled "Surgical Mortality and Type of Anesthesia Provider." The study analyzed the effect of different types of anesthesia providers--specifically Certified Registered Nurse Anesthetists (CRNAs) and physician anesthesiologists--on the death rates of Medicare patients undergoing surgery

    The results revealed that patients are just as safe receiving their anesthesia care from CRNAs or anesthesiologists working individually, or from CRNAs and anesthesiologists working together.

    A. Rationale for Undertaking Study
    According to the researchers, the study was undertaken:

    To attempt to answer lingering questions about surgical patients' safety related to types of anesthesia providers, even though estimates of anesthesia-related deaths today are as low as 1 in 200,000 to 300,000 cases. [To Err is Human: Building a Safer Health System. Kohn, LT, Corrigan, JM, Donaldson, MS. Washington, DC: National Academy Press. 1999.]


    To provide state governors with valid scientific data to help them decide whether their respective states should opt out of the federal physician supervision requirement for nurse anesthetists. [Federal Register. Vol. 66, No. 219, pp. 56762-56769.] Without such data, governors must rely on older studies (see analyses of Bechtoldt and Forrest studies, pp. 6-9 in this booklet) or seriously flawed studies (see analysis of Silber/Pennsylvania study, pp. 21-28 in this booklet).
    B. Background
    The researchers studied 404,194 Medicare cases that took place from 1995-1997 in 22 states. Only cases with clear documentation of type of anesthesia provider were studied, and adjustments were made for differences in case mix, clinical risk factors, hospital characteristics, and geographic location. The types of surgical procedures included carotid endarterectomies, cholecystectomies, herniorrhaphies, mastectomies, hysterectomies, laminectomies, prostatectomies, and knee replacements.

    Groundbreaking Results. The Pine study yielded the following important findings:

    Mortality rates were similar for CRNAs and anesthesiologists working individually.


    There was no statistically significant difference in the mortality rate for CRNAs and anesthesiologists working together versus CRNAs or anesthesiologists working individually.


    There was no statistically significant difference in the mortality rate for hospitals without anesthesiologists versus hospitals where anesthesiologists provided or directed anesthesia care.
    C. Conclusions
    Pine et al. concluded the following:

    That while their findings differed from those of Silber et al. (see analysis of Silber/Pennsylvania study, pp. 21-28 in this booklet), they were consistent with earlier research and with current data which estimate that anesthesia-related deaths today are as low as 1 in 200,000 to 300,000 cases. [To Err is Human: Building a Safer Health System. Kohn, LT, Corrigan, JM, Donaldson, MS. Washington, DC: National Academy Press. 1999.]


    That based on the surgical procedures included in the study, inpatient surgical mortality is not affected by whether the anesthesia provider is a CRNA or an anesthesiologist.
    Pine Versus Silber. The Silber/Pennsylvania study (see analysis on pp. 21-28 in this booklet), which was published nearly three years before the Pine study, contained glaring methodological deficiencies that Pine et al. endeavored to avoid. Specifically, approximately two- thirds of the cases which Silber et al. classified as not involving an anesthesiologist in the patient care either A) actually did have an anesthesiologist involved in some, but not all, of a patient's procedures, or B) had no bill for the anesthesia care (making it impossible to confirm whether an anesthesiologist was or was not involved).

    Further, cases in which anesthesiologists worked alone were not distinguished from those in which CRNAs and anesthesiologists worked together. Finally, only cases in one state--Pennsylvania--were included in the Silber study.

    This failure by Silber et al. to more accurately quantify the cases in which anesthesiologists were involved led the researchers to conclude that there was an increase of 2.5 deaths per 1,000 patients when an anesthesiologist was not involved in the case. This inflated ratio was alarmingly out of sync with the Institute of Medicine's (IOM's) published report that anesthesia mortality rates today are approximately 1 death per 200,000 to 300,000 anesthetics administered, a ratio also routinely cited by the American Society of Anesthesiologists (ASA). [To Err is Human: Building a Safer Health System. Kohn, LT, Corrigan, JM, Donaldson, MS. Washington, DC: National Academy Press. 1999.] Had Silber et al. identified a more accurate (i.e., larger) number of cases as involving anesthesiologists, the ratio obviously would have been much different.

    Pine et al. sought to avoid the limitations that marred the Silber study by taking the following steps:

    Studying cases from 22 states, instead of just a single state.


    Using only cases that clearly identified the type(s) of anesthesia provider involved in the patient care.


    Distinguishing between care provided by CRNAs and anesthesiologists working together and care provided by anesthesiologists or CRNAs working individually.
    The results of the efforts by Pine et al. to attribute anesthesia care to the correct providers) was twofold: 1) The researchers attained data that is more consistent with current overall anesthesia-related mortality rates cited by the IOM, the ASA, and the American Association of Nurse Anesthetists, and 2) they found no statistically significant difference in mortality rates when anesthesia is given by a CRNA working individually, an anesthesiologist working individually, or CRNAs and anesthesiologists working together.

    Pine Rebuttal to ASA Comments on Pine Study. In May 2003, the "ASA Preliminary Comment on Pine Study" was released. In a gross misinterpretation of the Pine study results, the ASA claimed that Pine et al. found 38 deaths per 10,000 cases in hospitals where anesthesiologists administered or directed all anesthetics, and 45 deaths per 10,000 cases when an anesthesiologist was not involved. From this, ASA suggested that "the Pine study data support what most recent studies have found--that anesthesiologists improve anesthesia outcomes." [ASA Preliminary Comment on Pine Study. Lobbying day handout. May 2003.]

    That same month, Dr. Pine wrote "Response to 'ASA Preliminary Comment.'" He stated that for the ASA to suggest that his study's data supports "the conclusion 'that anesthesiologists improve anesthesia outcomes'" is evidence of "either a woeful ignorance of the basics of data analysis or a cynical contempt for the intelligence of the intended audience." Defending his study, Dr. Pine wrote that his data actually found 34 deaths per 10,000 cases when CRNAs administered anesthesia while working together with anesthesiologists, and 45 deaths per 10,000 cases when anesthesiologists worked without a CRNA. He pointed out that this difference of 11 deaths per 10,000 cases was "even more impressive than the 7 deaths per 10,000 cases" difference cited by the ASA (see paragraph above), and that based on this data, "the AANA could claim that anesthesiologists should not be permitted to administer anesthesia unless a CRNA is present to prevent the excess mortality associated with physicians attempting to engage in the practice of nursing. However, unlike the ASA, the AANA has enough respect for its audience to avoid making such unwarranted claims."

    Dr. Pine reiterated his study's findings that after risk adjustment there is no statistically significant difference between CRNAs working individually, anesthesiologists working individually, or CRNAs and anesthesiologists working together. He added that his study's data support the conclusion that even when there are two anesthesia providers working together, substituting an anesthesiologist for a CRNA does nothing to lower the mortality rate. [Pine, M. Response to "ASA Preliminary Comment."www.aana.com. May 2003.]
    PMFB-RN, NRSKarenRN, and CNL2B like this.
  2. Visit  wtbcrna profile page
    0
    "Gastroenterologists State Their Case

    The societies' position supports the administration of propofol--a fast-acting, non-analgesic sedative--by non-anesthesiologists based on the outcomes of 29 studies and more than 460,000 cases, most of which involved nurse-administered propofol sedation. An updated article on the safety experience with endoscopist-directed propofol was published in October and now includes more than 600,000 cases (Gastroenterology 2009;137:1229-1237); the position statement was published in all four societies' journals in December 2009 (Am J Gastroenterol 2009;104:2886-2892; Gastroenterology 2009;137:2161-2167; Gastrointest Endosc 2009;70:1053-1059; Hepatology 2009;50:1683-1689)."

    http://www.anesthesiologynews.com/in...ticle_id=14584

    There is some outdated/inaccurate information about CRNAs in the article, but otherwise the article gives a decent update of the controversy of propofol being used in the GI suite.
  3. Visit  *traumaRN* profile page
    0
    Here is Dr. Rex, the director of endoscopy at Indiana University, discussing propofol administration by non-anesthesia providers.


  4. Visit  *traumaRN* profile page
    0
    Here is a link to a new study just released - As of March 1, 2010 done at Washington University in St. Louis MO.

    http://www.modernmedicine.com/modern...tegoryId=40127
  5. Visit  NEC1970 profile page
    0
    thanks for taking the time to reply to the authority on the subject - "Med student." Interestingly, just today, I was assigned to provide morning breaks and then lunches in a mixed CRNA/MDA staffed busy OR. After going room to room all day and also having done this a few times prior to today, what I find very interesting is how sloppy some MDAs are in pt care & organization. Few examples... pt eyes taped vertically with very thin tape so more than 50% of the eye is exposed, saw that a few times today in MDA rooms I relieved. Example again, numerous syringes uncapped/uncovered with meds scattered all about. Syringes left along side the pts arm where the IV is (i.e., neosynephrine, versed) and not one syringe was labeled with a date, concentration or dosage. Shame, Shame. how lazy can we get. CRNAs seem much more conscientous in this regard. I observed MDAs regularly give intubating dose of propofol without Lido and watch the pt grimace in pain. Again, the Lido is already drawn up for them, labeled and sitting right next to the propofol they slammed in. it is just lazy, anectdotal anesthesia practice. Either we care about pt safety 100% or not. This type of practice makes anesthesia all around look bad.
  6. Visit  wtbcrna profile page
    0
    Quote from freespirit2011
    Very interesting....non-anesthesiologists administering propofol? Totally unsafe.. And this includes unsupervised nurses (CRNA also)..
    Care to back up your statements with any research/proof? You can't so stop trolling.
  7. Visit  Seawitch profile page
    0
    We use it frequently in our ED to reduce dislocations etc. We just have a nurse that's accredited in Advance Life Support and Doc on hand.
  8. Visit  health professinal profile page
    1
    my experience with a tucson endoscopist and nurse pushing propofol was appalling. first the relevant background information:

    i had an intake with a dnp(c), fnp but didn’t schedule the colonoscopy on that same day so i wasn’t given the prep instructions. when i called later to schedule it, i was directed to get the instructions from their website.

    since i wasn’t able to talk with the endoscopist directly, i faxed this message to him: “as a 65 year-old retired health care professional who has worked in hospitals (i didn’t reveal in what capacity), i am aware that there are risks/ complications of colonoscopy related to sedation… actually, i would prefer no meds at all but i understand female physiology tends to make this procedure more difficult especially with a redundant colon, which i have…[so] i would like to have this noted on the consent form for my signature: no sedation; analgesics only- i.e. fentanyl and usage of a pediatric colonoscope…”.

    i also asked a staffer about the meds, and she responded, “i think it might be sedation or nothing at all”; but since she wasn’t sure, she referred my call to the endoscopy center (owned by the physicians) where i spoke to a nurse who told me that he uses propofol, while also assuring me that i have rights as a patient.

    the day before the scheduled procedure, his med asst called and relayed his non-committal response i.e. that he would speak with me about the meds before the procedure. i then said that i needed to know beforehand whether he would agree to my request. her response was, "procedures are done here without sedation all the time". when i asked about the pediatric scope, her response was, “we have pediatric scopes in the center”. i also noticed that she said nothing about the analgesic; but i realized i probably wouldn’t get a direct answer to that either, so i left it at that and decided to keep the appointment, and anticipated pressure to agree to the propofol. (i think reading about his military background added to that anticipation).

    on the day of the procedure, as i lay on the gurney awaiting his arrival in the examinationroom, i reported to the nurse that i was quite nervous and my heart was beating fast. as i expected, when he arrived, he (and she) tried to pressure me to take the propofol and to discourage me from taking the fentanyl. when i insisted on having only an analgesic so that i could be awake during the procedure and refused the propofol unless the pain became too great, he seemed annoyed; and when he instructed the nurse to administer 50 mg of fentanyl and i asked if he could start at 25 mg, he angrily and insistently demanded to know if i had medical training (fearing more hostility, i avoided mention that dosage is recommended in some guidelines for geriatric patients); and then when he asked what was written on the instruction sheet re the second prep dose and i explained that one had not been written, he retorted, "i don't believe that!" -in essence calling me a liar. in addition to feeling weak from having no food for 24 hours as part of the prep, i felt quite nervous and intimidated: but what followed was even worse:

    i had read that fentanyl ““is approximately 100 times more potent than morphine"; so of course my expectation was that fentanyl would relieve any pain. however, i experienced excruciating pain a few times during the procedure even though i heard him give instructions to titrate the fentanyl twice. in fact, i felt none of the narcotic effects - no analgesia, no relaxation, no euphoria, no drowsiness, nothing; and no nausea afterwards as he had warned.

    naturally this raises suspicions, especially after reflecting on the responses of the medical assistant and aforementioned phone staffer, as well as the nurse’s warning before the procedure began: take deep breaths when you experience pain because if you don’t, the pain could make you tighten up, causing the colon to contract and exacerbate the pain. since i have ibs, it’s possible that my colon was already in spasm.

    also, i read in gastroenterology & endoscopy news that one of the reasons some gastroenterologists push propofol is because the recovery period is minimized, so their costs are reduced.

    note: my first colonoscopy was a pleasant experience. i was administered only a narcotic; and during the procedure i was fully awake, experienced euphoria and no pain and had no nausea afterwards- the same experience i had when i was given a narcotic after a surgery in 1971. however, while under anesthesia during that surgery, even though i wasn't conscious, i experienced a horrifying nightmare. i would imagine that undergoing surgery for most people is probably more physically painful than a colonoscopy but in any case, it is possible to experience such unconscious aspects of pain while under anesthesia. (i also read such reports by other colonoscopy patients). this is another reason i opted only for pain meds during this colonoscopy.

    ps. note these familiar remarks from your website:
    http://allnurses.com/gastroenterolog...es-377308.html
    recently, a patient told me that the gi lab at our hospital told her: either accept sedation or you won't get anything for pain. seems a little one-sided to me, but i called to schedule a colonoscopy and was told the same thing. one gi nurse said it might be a way to convince everyone to accept sedation...for colonoscopy where propofol is given, do you also administer a narcotic (ie fentanyl) or just use propofol? i'm asking because i have noticed an increase in patient dissatifaction with colonoscopy with propofol when fentanyl was not used; and this is important to me since many patients pay extra for it when i suggest propofol. up until recently, every patient who had colonoscopy with anesthesa coverage (propofol) was satisfied; now i am running into a lot of patients who had propofol and would never consider another exam because of painful memories. and when i review their charts, they are always the ones who got propofol without any narcotic.
    Last edit by health professinal on May 16, '11 : Reason: grammar corrections
    MaudKennedy likes this.
  9. Visit  wtbcrna profile page
    1
    Quote from health professinal
    my experience with a tucson endoscopist and nurse pushing propofol was appalling. first the relevant background information:

    i had an intake with a dnp(c), fnp but didn't schedule the colonoscopy on that same day so i wasn't given the prep instructions. when i called later to schedule it, i was directed to get the instructions from their website.

    since i wasn't able to talk with the endoscopist directly, i faxed this message to him: "as a 65 year-old retired health care professional who has worked in hospitals (i didn't reveal in what capacity), i am aware that there are risks/ complications of colonoscopy related to sedation... actually, i would prefer no meds at all but i understand female physiology tends to make this procedure more difficult especially with a redundant colon, which i have...[so] i would like to have this noted on the consent form for my signature: no sedation; analgesics only- i.e. fentanyl and usage of a pediatric colonoscope...".

    i also asked a staffer about the meds, and she responded, "i think it might be sedation or nothing at all"; but since she wasn't sure, she referred my call to the endoscopy center (owned by the physicians) where i spoke to a nurse who told me that he uses propofol, while also assuring me that i have rights as a patient.

    the day before the scheduled procedure, his med asst called and relayed his non-committal response i.e. that he would speak with me about the meds before the procedure. i then said that i needed to know beforehand whether he would agree to my request. her response was, "procedures are done here without sedation all the time". when i asked about the pediatric scope, her response was, "we have pediatric scopes in the center". i also noticed that she said nothing about the analgesic; but i realized i probably wouldn't get a direct answer to that either, so i left it at that and decided to keep the appointment, and anticipated pressure to agree to the propofol. (i think reading about his military background added to that anticipation).

    on the day of the procedure, as i lay on the gurney awaiting his arrival in the examinationroom, i reported to the nurse that i was quite nervous and my heart was beating fast. as i expected, when he arrived, he (and she) tried to pressure me to take the propofol and to discourage me from taking the fentanyl. when i insisted on having only an analgesic so that i could be awake during the procedure and refused the propofol unless the pain became too great, he seemed annoyed; and when he instructed the nurse to administer 50 mg of fentanyl and i asked if he could start at 25 mg, he angrily and insistently demanded to know if i had medical training (fearing more hostility, i avoided mention that dosage is recommended in some guidelines for geriatric patients); and then when he asked what was written on the instruction sheet re the second prep dose and i explained that one had not been written, he retorted, "i don't believe that!" -in essence calling me a liar. in addition to feeling weak from having no food for 24 hours as part of the prep, i felt quite nervous and intimidated: but what followed was even worse:

    i had read that fentanyl ""is approximately 100 times more potent than morphine"; so of course my expectation was that fentanyl would relieve any pain. however, i experienced excruciating pain a few times during the procedure even though i heard him give instructions to titrate the fentanyl twice. in fact, i felt none of the narcotic effects - no analgesia, no relaxation, no euphoria, no drowsiness, nothing; and no nausea afterwards as he had warned.

    naturally this raises suspicions, especially after reflecting on the responses of the medical assistant and aforementioned phone staffer, as well as the nurse's warning before the procedure began: take deep breaths when you experience pain because if you don't, the pain could make you tighten up, causing the colon to contract and exacerbate the pain. since i have ibs, it's possible that my colon was already in spasm.

    also, i read in gastroenterology & endoscopy news that one of the reasons some gastroenterologists push propofol is because the recovery period is minimized, so their costs are reduced.

    note: my first colonoscopy was a pleasant experience. i was administered only a narcotic; and during the procedure i was fully awake, experienced euphoria and no pain and had no nausea afterwards- the same experience i had when i was given a narcotic after a surgery in 1971. however, while under anesthesia during that surgery, even though i wasn't conscious, i experienced a horrifying nightmare. i would imagine that undergoing surgery for most people is probably more physically painful than a colonoscopy but in any case, it is possible to experience such unconscious aspects of pain while under anesthesia. (i also read such reports by other colonoscopy patients). this is another reason i opted only for pain meds during this colonoscopy.

    ps. note these familiar remarks from your website:
    http://allnurses.com/gastroenterolog...es-377308.html
    recently, a patient told me that the gi lab at our hospital told her: either accept sedation or you won't get anything for pain. seems a little one-sided to me, but i called to schedule a colonoscopy and was told the same thing. one gi nurse said it might be a way to convince everyone to accept sedation...for colonoscopy where propofol is given, do you also administer a narcotic (ie fentanyl) or just use propofol? i'm asking because i have noticed an increase in patient dissatifaction with colonoscopy with propofol when fentanyl was not used; and this is important to me since many patients pay extra for it when i suggest propofol. up until recently, every patient who had colonoscopy with anesthesa coverage (propofol) was satisfied; now i am running into a lot of patients who had propofol and would never consider another exam because of painful memories. and when i review their charts, they are always the ones who got propofol without any narcotic.
    i am not sure what kind of health professional (not professinal) you were, but you have some misunderstandings about certain medications and dosages.

    1. fentanyl in general is somewhere between 75-100x more potent than morphine, but it isn't given in mg (milligrams) it is given in mcg (micrograms) if they had given you 75mg of fentanyl you would have coded immediately from respiratory depression.
    2. there is more than 1 reason to give other medications with the fentanyl. the meds we usually use in combination for sedation work synergistically, and allow us to use each one in lower doses while providing more consistent sedation/analgesia.
    3. using a pediatric scope degrades the quality of your colonoscopy by decreasing the view. i don't really understand why someone would want to put themselves through colonoscopy to have poorer than standard imaging that could miss the findings you are getting the colonoscopy for in the first place.
    4. demanding that a procedure to be done a certain way that is unfamiliar to the provider and nursing staff is a certain way to expect poor outcomes. a gi doc that isn't familiar with giving only narcotics for gi procedures is going to have a hard time ordering an effective dosing to cover procedure.
    5. there isn't a conspiracy among healthcare providers to try to just make more money and move patients through. the recommendation to use propofol with or without versed/fentanyl for gi sedations has been shown in well over 300k cases to be the most beneficial to patients undergoing sedation in the gi suite. propofol sedation provides quicker recovery, quicker return to baseline cognitive function, hemodynamic stability in asa 1-4 patients, better patient satisfaction, and better provider satisfaction.

    here are some good references (see the bottom of the page):
    http://www.gastroenterologistnewyork...enterology.php
    Horseshoe likes this.
  10. Visit  health professinal profile page
    0
    typo- mcg vs mg.

    The Endoscopy Center said all they use is a pediatric scope.

    I mentioned financial incentives but I didn't say there is a "conspiracy among healthcare providers to try to just make more money and move patients through".

    You mention nothing about the endoscopists behavior and possible deceit; so I guess that's OK with you.
  11. Visit  health professinal profile page
    0
    single use of fentanyl in colonoscopy is safe and effective and significantly shortens recovery time.

    lazaraki g, kountouras j, metallidis s, dokas s, bakaloudis t, chatzopoulos d, gavalas e, zavos c.
    department of medicine, second medical clinic, ippokration hospital, aristotle university of thessaloniki, thessaloniki, greece. lazarakg@yahoo.com
    abstract

    colonoscopy remains an uncomfortable examination and many patients prefer to be sedated. the aim of this study was to evaluate the efficacy and safety of intravenous administration of fentanyl in titrated doses compared with intravenous administration of the well-known midazolam in titrated doses.

    methods: one hundred twenty-six patients scheduled for ambulatory colonoscopy were randomly assigned to receive either 25 mcg fentanyl (fentanyl group, n = 66, 35 females, mean age = 61.5 years) and titrated up to 50 mcg or 2 mg midazolam (midazolam group, n = 60, 33 females, mean age = 63.2 years) and titrated up to 5 mg. patients graded discomfort on a scale from 0 to 4 and pain on a scale from 0 to 10. success of the procedure, time to cecum, complications, and recovery time for each patient were independently recorded.


    results: mean discomfort scores were 0.4 in the fentanyl group and 1.0 in the midazolam group (p = 0.002). similarly, mean scores for pain and anus to cecum time were lower in the fentanyl group than in the midazolam group [2.59 vs. 4.43 (p = 0.002) and 8.7 vs. 12.9 min (p = 0.012), respectively]. no adverse events were reported in the fentanyl group, while in the midazolam group a decrease in oxygen saturation was noted in 23/60 (35%) patients. mean recovery time was 5.6 min in the fentanyl group and 16 min in the midazolam group (p = 0.014). mean dosage was 36 mcg for fentanyl and 4.6 mg for midazolam.


    [color=#323232]conclusion: administration of fentanyl in low incremental doses is sufficient to achieve a satisfactory level of comfort during colonoscopy.


    pmid: 17762959 [pubmed - indexed for medline]


    gastroenterology & endoscopy issue: september 2008 | volume: 59:09

    propofol sedation for colonoscopy: a consensus?
    compiled by christina frangou
    propofol, the powerful anesthetic often used to sedate patients for colonoscopy, continues to stir up plenty of controversy in the field of gastroenterology....
    Last edit by health professinal on May 17, '11 : Reason: forgot to include source
  12. Visit  health professinal profile page
    0
    PS. I was trained in psychiatry where compassion was emphasized. I did not work for a drug manufacturer.
  13. Visit  health professinal profile page
    0
    Perhaps it's time to review this?:
    A Patient’s Bill of Rights
    A Patient's Bill of Rights was first adopted by the
    American Hospital Association in 1973.

    Effective health care requires collaboration between patients and physicians and other health care professionals. Open and honest communication, respect for personal and professional values, and sensitivity to differences are integral to optimal patient care. … must ensure a health care ethic that respects the role of patients in decision making about treatment choices and other aspects of their care. The collaborative nature of health care requires that patients, or their families/surrogates, participate in their care.
    All these activities must be conducted with an overriding concern for the values and dignity of patients.


    Bill of Rights

    1. The patient has the right to considerate and respectful care.
    2. The patient has the right to and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment, and prognosis.

    Except in emergencies when the patient lacks decision-making capacity and the need for treatment is urgent, the patient is entitled to the opportunity to discuss and request information related to the specific procedures and/or treatments, the risks involved, the possible length of recuperation, and the medically reasonable alternatives and their accompanying risks and benefits.


    3. The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. In case of such refusal, the patient is entitled to other appropriate care and services that the hospital provides or transfer to another hospital. The hospital should notify patients of any policy that might affect patient choice within the institution.
    4. The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and/or referral as indicated by the urgency of the case. ..
    5. The patient has the right to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patient's treatment and care…

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