Protocols for discharging patients who have sedation

Hey, Mike. Talk to your gastro about having your colonoscopy w/o sedation. Also: check out these two abstracts and give your gastro a copy.

A Study of Pain During Colonoscopy

http://www.e-health-questions.info/h...&realm=default

Why Colonoscopy Is More Difficult In Women

http://www.e-health-questions.info/h...&realm=default

From the Journal of The Royal College of Surgeons of Edinburgh, here's an article by a "teaching colonoscopist" that details the whole procedure, including some of the things that can go wrong. It's called, How I do it, by A. LESLIE and R.J.C. STEELE, University Department of Surgery and Molecular Oncology, Ninewells Hospital, Dundee DD1 9SY, U.K.

http://www.rcsed.ac.uk/journal/vol47_2/4720010.html

I have my colonoscopies w/o sedation. We do use 25 mg of Demerol and if my vagus nerve gets in a twit at the transverse colon/hepatic flexure and causes me to start dry heaving I'm given a little bit of Phenergan to "humor" that vagus nerve.

My gastro and I had some pretty "strenuous" debates about whether I would have sedation or anesthesia or nothing for my colonoscopies. She finally agreed only after reading the above two articles and undergoing both the upper and lower scope w/o sedation herself. Even then we had to compromise to reach agreement which is why I get the Demerol. She agreed with me that the upper scope is worse w/o sedation than the lower due to the gag reflex during the upper.

The Demerol provides analgesia but not the sedating/memory blocking effects.

We discharge our patient from recovery when vital signs have returned to baseline, the patient is awake, alert, and able to assist in ADLs, ie:dress themselves. We have no specific recovery time, it is patient and situation specific, as every patient has different needs.
We discharge via w/c to auto, responsible adult with them to assume care (not a taxi driver). D/c instructions include no alcohol for 24 hrs, no driving, clause for narcotics being admin. re:workplace drug testing.
Patients are given and explained discharge criteria PRE procedure. Discharge criteria administered on admit.

Our Endo unit will not even take the patient to the dressing room to change unless they have an adult with them to drive them home. Prior to being taken to the dressing room they are given discharge instructions similar to those above and they must sign them prior to changing as well. Only after all that is taken care of is the patient taken to change into a gown and their IVs set, etc. The adult accompanying them is shown the waiting room and told if they leave to go to the cafeteria or to make a phone call they MUST advise the nurses' desk accordingly.