Question about drugs used for endoscopy

Specialties Gastroenterology

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Hi! I am a pre-nursing student and I thought I would incorporate my recent experience into a paper I'm writing on the effects of drugs on the nervous system. I had an endoscopy yesterday to dx a 4 cm hiatal hernia (oh joy! at least I know I'm not having heart attacks, just hernia pain). I was given a printout of the procedure and findings as well as some fun photos of my insides. I started to research the drugs I was given:

7 mg of Midazolam IV

100 mg Meperidine IV

25 mg Diphenhydramine IV

I noticed in researcing the Midazolam that the websites said to give 1 mg for endoscopy and not more than 5 mg, rarely up to 10. I am 120 pound female. Is that a standard dose of the med for someone my size or did I get extra because I was so extremely nervous and freaked out?:uhoh21:

Also curious-- do you think I was really still awake during the procedure. Of course I don't remember anything except my husband putting my shoes on afterwards, and I can't even remember how I got home, much less the conversation I reportedly had with the doctor about his findings. During such procedures using the drugs listed above are the patients usually awake? Are they kinda out of it or can they still cooperate during the procedure if the doctor says to bite down on the mouth thing or whatever.

Normally I can take a child's dose of Benedryl if I have trouble sleeping. I'm pretty sensitive to drugs. Do some patients fall asleep or do they all stay awake. I guess it kinda bothers me that maybe I was awake and can't remember what I did. :lol2: All I know is it took me the rest of the day to sleep off the drugs and I was not really feeling myself for about 12 hours.

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Yep, that was a S**T load of drugs.

Are you sure that the versed was 7mgm......not 2, kinda looking like a 7?

Even 2mgm of Versed.....topped off with 100 Demerol ...IV no less, should just about bring you to apnea. I guess that the 25mg of benadryl was used as a little "kicker", just to mellow you out. Who the hell was anesthesia?

Sure, I've given that much and more to post operative major surgery patients in the recovery room...............but they WERN'T going home.

Never have I given more than 4 mgm of versed to anyone at one time and only intubated.

Chuck

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Yep, that was a S**T load of drugs.

Are you sure that the versed was 7mgm......not 2, kinda looking like a 7?

Even 2mgm of Versed.....topped off with 100 Demerol ...IV no less, should just about bring you to apnea. I guess that the 25mg of benadryl was used as a little "kicker", just to mellow you out. Who the hell was anesthesia?

Sure, I've given that much and more to post operative major surgery patients in the recovery room...............but they WERN'T going home.

Never have I given more than 4 mgm of versed to anyone at one time and only intubated.

Chuck

I would second that. It is a large dose, I have seen that much used, but in much larger patients. Hopefully it was 2mg not 7. The real question is who uses demerol anymore. Hmm a drug with a two hour half life for a 15 minute procedure. Doesnt make much sense. I used 10mg of Versed as a Paramedic for a seizure but that is a different Oprah.

David Carpenter, PA-C

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That is a lot of Versed but not more than our hospital policy allows us to give. We titrate it, starting out with 2.5 mg and give another mg every 2 minutes as needed. The maximum allowed is 7.5 mg. We haven't used Demerol for a long time....it's not used anywhere in our facility anymore, but the max on that was 100 mg. Now, for Endoscopy, we use Fentanyl. And I'm sure you didn't say anything you should be ashamed of. If people are awake enough to need more medication, they're usually just verbalizing that it hurts and they need more. The amnesia is normal....and the long-lasting sedation. That's why you need to have someone with you so they can relate what the doctor's findings were.

Find a Center that uses Propofol next time. It's SO much better! You go down immediately and wake up, without the sedating effects, in minutes. A CRNA has to administer it so it's more expensive, but it's safer and so much more tolerable.

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In the office where I work it is not at ALL uncommon for people to recieve that much or more of Versed. Especially for younger people, though I may be wrong in assuming that. We generally do not use demerol though, we use fentanyl. When we give the drugs they are titrated so that we can avoid causing breathing or cardiac problems.

You say that you are sensitive to drugs; one of our doctors says that as soon as anyone tells him that he knows to bring out the sledgehammer because they will be very difficult to sedate.

Also keep in mind that other medications you take can change the way you process the meds, SSRI's in particular, causing you to need more medication.

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Specializes in surg, gu, gi iv.

Hi, It s not unusual for us to give that much versed and more especially in young anxious pts. We are using MAC now more and more with anesthesiologists giving propafol . It works much quicker and pts wake up much quicker without the hangover effect. Hope this helps.

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Specializes in Transplant, Surgical, Internal Medicine.

This is not uncommon in our facility either. Typically for an upper I use 4-6 of versed and 50 of Fent. You also must consider your patient when titrating drugs, as I have given 10 of versed and 100 of Fent and the pt is still wide awake having a conversation with you about the weather. Propafol is a good option, but not available to every patient. Once again, the insurance companies rule this one, and the almighty dollar trumphs patient care...our patient mix is 70% Public Aid and HMO...which of course do not pay for MAC. The sad reality is that 70% seem to need the propafol more than the insurnace pt. in a lot of cases, and would then have a more positive experience, while the other 30% could have a gastro with 2 of versed and probably no fent.:o

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I know this is an old post---I metabolize these type meds quickly--for my colonoscopy--I had 200 fentanyl, 7 of versed, AND propofol!!! -

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Specializes in PACU, NICU.

it is not at all uncommon to receive that much medication for an egd or colonoscopy. the use of fentanyl vs. demerol is certainly a facility choice & administering 50 - 100 of either drug is common as well as, as much as up to 10mg of versed. the amnesia after the procedure is created by the versed & that is why it is used, but yes, patients are "awake" and following the commands of the staff during the course of the procedures. it is common and expected that the patients are discharged without memory of the procedure & typically will have that experience for the rest of the day! the addition of benadryl is something i've never seen in my practice, but again that would be a practitioner preference. the hangover you experienced is more likely associated with the use of the benadryl.

to use propfol changes things ~ that means a costly trip to or for anesthesia to provide that level of sedation vs. using the endopscopy suites! completely unnecessary, especially when being able to complete the procedure with moderate sedation without difficulty. propofol should only be used for the patients that you are unable to provide enough moderate sedation to complete the procedure and again in that case must be done in the or.

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