to sedate or not to sedate...

  1. at my facility, anesthesia does not sedate during intubation.. the patient is fully awake, writhing, looks uncomfortable and probably in pain through the whole process.. when i ask them why not some propofol or whatever, they say it's better/safer for the patient, i.e. aspiration or the like. at this point, i say, what's the difference, they end up on sedation as soon as the tube is in. i shake my head in disgust. if there's one thing that bothers me the most at my job, is this. your thoughts?
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  2. 48 Comments

  3. by   pricklypear
    We always sedate, unless the pt is already unresponsive. Seems like they'll do less gagging if they're sedated, therefore less likely to vomit.
  4. by   Mayflye
    It is unconscionable not to sedate. How would the anesthesiologist like it if it was done to him/her? Did Saddam Hussein teach them intubation skills?

    You are absolutely right about the sedation. That's why we suction and put the head of the bed up/ng tube/whatever.

    Perhaps your nurse manager could address this and supply some type of information/standard of care to the docs. We are our patient's advocates!
  5. by   ZASHAGALKA
    1. I would certainly refuse to participate on ethical grounds.

    2. I would refer every instance for ethics review.

    3. I would demand evidence based research on that rationale.

    ~faith,
    Timothy.
  6. by   Dinith88
    Quote from ZASHAGALKA
    1. I would certainly refuse to participate on ethical grounds.

    2. I would refer every instance for ethics review.

    3. I would demand evidence based research on that rationale.

    ~faith,
    Timothy.

    Just like he said...
  7. by   dfk
    i hear all of u.. it's the doctor's call, not our nurse mgr. (who just resigned - YAHOOOOO!!!) it seems to be somewhat of common practice from what i am gathering (doc wise). at this point, ethics committee won't get involved (the same nurse mgr that's resigning was on committee)- how funny is that? i'd be interested to take a poll of those that got tubed and ask of experience
    r/t awake/asleep, and their thoughts. (not that breathing thru a large straw is not memorable enough!!) -
  8. by   Jerico
    Where ARE you practicing?

    I just want to stay away.....
  9. by   marissa81579
    I am not sure this is an ethical issue either. There is no evidence that sedating a patient during intubation is helpful; it is just more comfort and it makes the procedure far easier - I have been in rooms when someone is getting intubated hundreds of times and when they are wide awake, it is next to impossible.

    I would be interested in research based rationales for why they do not sedate during intubation. But I can understand why the ethical committee will not get involved, as uncomfortable as the procedure may be for patients.
  10. by   ZASHAGALKA
    Quote from marissa81579
    I am not sure this is an ethical issue either. There is no evidence that sedating a patient during intubation is helpful; it is just more comfort and it makes the procedure far easier - I have been in rooms when someone is getting intubated hundreds of times and when they are wide awake, it is next to impossible.

    I would be interested in research based rationales for why they do not sedate during intubation. But I can understand why the ethical committee will not get involved, as uncomfortable as the procedure may be for patients.
    I'm sure they would get involved if you accurately and assertively point out that JCAHO demands that measure be in place to ensure adequate and effective pain control.

    Effective pain control is a nationwide directive from our governing body and failing to do so without good cause is a deviation and violation of our accreditation commitments.

    It is an ethical issue. Needlessly submitting somebody to pain is unethical.

    ~faith,
    Timothy.
  11. by   marissa81579
    I am well aware of JCAHO pain initiatives but it does not hurt to get intubated, it is simply uncomfortable - I think it is a matter of "best practice" - it sounds like the physicians at that hospital are afraid to sedate patients!

    I am not advocating the behavior, I think it is awful. But there is nothing inherently painful about getting intubated, particularly since they numb people's throats before doing it also.

    Discomforting feeling getting a tube shoved down your airway? Sure. But I don't discomfort equals pain. But I agree that patients should be sedated. But you can't lose sight of why they are sedated - it's done for ease of the whole process and so they won't remember it - not for strictly "pain control"
  12. by   ZASHAGALKA
    Quote from marissa81579
    I am well aware of JCAHO pain initiatives but it does not hurt to get intubated, it is simply uncomfortable - I think it is a matter of "best practice" - it sounds like the physicians at that hospital are afraid to sedate patients!

    I am not advocating the behavior, I think it is awful. But there is nothing inherently painful about getting intubated, particularly since they numb people's throats before doing it also.

    Discomforting feeling getting a tube shoved down your airway? Sure. But I don't discomfort equals pain. But I agree that patients should be sedated. But you can't lose sight of why they are sedated - it's done for ease of the whole process and so they won't remember it - not for strictly "pain control"
    Not trying to just be contrary to you.

    But I see little difference between extreme discomfort and pain.

    And in this case, it isn't a 'best practice' issue; it's a 'worst practice' issue. It's bad enough to be unethical.

    I'm a patient advocate: I could not in good conscience participate in an activity that is tantamount to abuse. Indeed, I have a legal obligation to report such abuse to the appropriate state agency. No, I'm not suggesting that to be an option: but I am saying that it comes perilously close to being in such bad form that it falls under that umbrella.

    Intubation is a highly invasive procedure. The JCAHO standard does indeed include providing effective pain control measures for the performance of invasive procedures.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Dec 7, '05
  13. by   marissa81579
    I do think there is a different between pain and a less than "pleasurable" feeling that being intubated provides. Opiates are contraindicated for intubation anyways - sedatives are used and that is because it makes it easier to intubate a patient in a controlled situation. I don't know what other research says that makes these doctors not sedate for intubating, but I guess it has something to do with aspiration? I really dont know. Either way, I think you framing this as a "pain control" issue is absolutely incorrect. Is it cruel to intubate someone wide awake? I would imagine. Perhaps in those terms it does fall into an ethical framework, but not under pain management terms because it is a painless procedure.

    You can't generalize all invasive procedures as requiring pain control. It is a little bit more complicated than that!
  14. by   Mayflye
    I never see docs use the cetacaine spray, and rarely the lido gel. Marissa, haven't you seen the docs cranking around with the blade so that you think it's going to pop out their crichoid? That's PAIN, not discomfort. Look at the patients eyes, I've seen it happen.

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