Average doseage of conscious sedation while doing endoscopy's

EndoRN · May 28, 2001

There is absolutely no "average" dose. Some 300 lb. man may take only 25 of Demerol and maybe 1-2 of Versed whereas some tiny little old lady may take 150 and 7!

Where I work we are all required to be certified in IVCS. I don't think anyone should be pushing these meds that is not! I would definitely recommend you and your staff looking into getting educated!

Picking an "average" dose and pushing it is a VERY scary thought!!

[ May 28, 2001: Message edited by: EndoRN ]

GInurse · May 29, 2001

I work for a gastroenterologist and assist with endoscopy daily. I am the one who administers the conscious sedation and I determine how much medication is enough. He has given me that responsibility. While I do agree with the above post, there IS an average dose. We give Demerol and Versed as well, and also use Benadryl for added sedation if necessary.

We always draw up 50mg of Demerol and 5mg of Versed to start. I start sedation with all 50 mg of the Demerol, unless the patient is very elderly, or otherwise compromised, and 1 mg of Versed. For younger people or very anxious people, I usually start with 2 mg of Versed.

I would say an average dose of Demerol is 50 mg and an average dose of Versed is 3-5 mg. However, we have used up to 150 mg of Demerol, and 15 mg of Versed - especially during ERCP's.

One of our partners uses about 30 mg of Versed during his Endo-cinch procedures.

Hope this helps to answer your questions.

P.S. Are you a member of SGNA???

prmenrs, RN · Jun 20, 2001

I had this proceedure done to me yesterday. I haven't had that much pain since I had appendicitis! I was told I got 100 of Demoerol and 5 of versed, but I'm here to tell you IT DIDN'T WORK!! I remember everything, including saying ouch continuously throughout the fun and asking them to stop at least twice.

Can anyone explain why they didn't stop and get the pain under control?

When I asked later why it hurt so much the doc mumbled something about me being "too fat"! (I am fat, but I don't believe that's why it hurt so bad, and if that's really the case, why wasn't I warned ahead of time?)

It's been >24hours, and everytime I think about this, I start crying.

Any insight you can provide would be appreciated. Thanks

EndoRN · Jun 25, 2001

prmenrs,

That sucks! I'm so sorry that happened to you. I work at an outpatient surgery center now, doing GI. We have anesthesia there so I don't have to do my own sedation anymore. It's wonderful!

But what happened to you really isn't the norm with IV conscious sedation! We would experience someone from time to time that we had that problem with, but 90% of the time we were able to keep people very comfortable. 100 and 5 is a pretty decent dose, but some people do require more than that to keep them comfortable! And, supposedly, the more people weigh, the more of the meds they do need. But, honestly, in my experience, it seems to make no difference whatsoever. I've see "fat" people get totally snowed on small doses and vice versa. It's all so individualized.

You may also have had a real long and twisty colon which is sometimes harder to get through and more uncomfortable.

Nevertheless, I am sorry you were so uncomfortable. Next time you have this done, maybe your doctor will have it done by anesthesia vs. IVCS.

And please don't think "there will be no next time" because this test is SO important. I have learned so much about the importance of colon CA screening since going into GI a few years ago!

prmenrs, RN · Jun 25, 2001

Thanks for responding! I am on antidepressants, and my psych told me that could have affected how the drugs were metabolized and how I felt afterward. That helped a lot! Maybe for pts like me who are on more than a couple of meds, a pharmacist should review the profile and advise. I'm going to make that suggestion.

Again, Thank you for your help. It will be a long time before I do this again, even though I realize the importance!

endomarge · Jun 26, 2001

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Originally posted by endomarge
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There is no average dose for any conscious sedation..... In our Endoscopy unit our doctors are very well educated in the conscious sedation protocal. The doctor orders versed and Fentanyl...depending on the age of the patient, procedure,and vital signs before the procedure, and during the procedure.

If the doctor is rough, and is a hurry he may order more medication than is needed....we have the right to refuse depending on the vital signs.....we have one doctor that is so gentle his patients usually are medicated with fentanly 50 mcg and 1 mg of Versed!!!!!!!!!!!!!!:) WE have one doctor that is extremely rough and his patients for an EGD someitmes if vital sign are stable will order 100 mcg of Fentanly to 6 mg of Versed:eek: In our Endoscopy unit a RN gives all the meds and the other RN or tech assists the physician:o Our Endoscopy record covers all aspects: pre procedure, during the procedure and post procedure. re@ patient LOC, discomfort during the procedure....The patient is recovered in the endo dept and discharged to an adult with discharge instructions:)

endoshirley · Jun 27, 2001

I work at a large university hospital. We use Demerol, Fentanyl, Versed, and Inapsine or Benadryl. For some reason, the patients are being told they will be "knocked out" and so they expect to be totally asleep. It takes a few more minutes of teaching time to straighten that out. My average dose that I think works well on most people, including the healthy elderly, is 75 of Dem or Fent, plus 3 of Versed, plus up to 2.5mg of Inapsine. This seems to provide a very good amnestic effect, and yes, the patients are discharged under their own power. Our docs are starting a study on the efficacy of Benadryl, as there has only been anecdotal reports about its effectiveness. I agree with EndoMarge that a doc's experience and gentleness make all the difference in the world when it comes to how much sedation a patient needs for the average colon or egd. But for procedures like ERCP and EUS, when it is important to keep the patient still, sometimes you have to give alot more than you expected. By the way, we do a fair amount of our ERCPs under GA; I mean at least it's not a big deal to get it scheduled, etc. Also, we have our own fluoroscope (C-arm) so we don't have to hassle with the xray dept at all.

mkaren73 · Jul 7, 2001

We have average doses in the endoscopy department where I work but it also does depend on the size, age and sex of the patient. As a general rule, we draw up 5 mg of Versed and 100 mg of Demerol for a colonoscopy and 5 mg of Versed and 50 mg of Demerol for endoscopies.

tamdsandlin · Sep 8, 2001

I used to be a GI nurse and I worked with a specialists. I am also very sorry that you had a bad experience with your c-scope. Most of the time patients say that the prep the night before was worse than the actual scope! Everyone is different though and it is an uncomfortable procedure. Just making an appointment @ a GI office is enough to make you uncomfortable! Please don't let this experience keep you from doing it again. If they took any biopsies, in about a week the results will be back. If you had any polyps, it is VERY important to have this test done again anywhere from 1-5 yrs. (depending on type of polyp). Choose another GI Doc next time or schedule an appointment (or @ your follow up appt.) to tell you Doc how uncomfortable you were and maybe next time he'll know how your body responds to the meds better. I would personally think it would be easier to stick with the same Dr. because you won't be as nervous next time and with your records etc... If any doctor called me "fat," and did'nt adjust my meds because of that, I think I would take my business somewhere else. Hope everything goes well.

**canoehead, BSN, RN** · Sep 8, 2001

I am outraged that a doc would leave a patient in pain, and insult them. I also think that the fact that you said "stop" repeatedly and they kept going is grounds for a suit. I would be very clear about what "stop" means before allowing sedation again. I don't blame you for being upset.

Are you going to get to talk to this doc again, maybe ask why he didn't respond to your requests?

swmn · Dec 11, 2001

I draw up 5 and 100 when I am using Versed and Demerol, 10 and 250 when I am using Valium and Fentanyl. Drope comes in 5mg ampules, so that is a no brainer too.

When it is my turn, I want fentanyl and versed. On integrated units where recovery is handled by other endo procedure nurses I would say 50 of demerol and 3-5 of versed is pretty typical with gentle docs and healthy outpatients. Females who have had lots of babies might need 75 or even 100 of D, but all these folks will recover and walk out pretty quickly.

Anyone on maintenance opiods or benzos for pain/panic etc is going to be a little tougher to sedate. Anyone taking about 30mg morphine or 10mg diazepam PO at a single dose is going to make my short list for droperidol, along with everyone who drinks alcohol everyday or is currently using marijuana, cocaine or crystal meth. The "seekers" asking about vicodin for the post procedure pain they haven't even felt yet frequently make my drope list too.

If there are some pulmonary issues to consider I'll go heavier on the versed and layoff the D. Patients on maintenance valium I lean away from the versed and push the D a little harder (if I can't talk the doc into using fentanyl). Those little lines on the 5cc syringe of versed are 0.2mg each

Frankly I dilute my Demerol to 10mg:1cc in a 10cc syringe and will go with 2mg incremental doses if it is indicated. My smallest dose on an ancient inpatient was 0.6 of valium and 12mg of Demerol for a very long colonoscopy. Sometimes I can time 5 of versed, 100 of demerol _and_ 5 of drope to all peak at the same time and still have to talk the patient through an EGD.

For obese patients without respiratory compromise I am more than happy to start with 2&50, and then run the versed up in more or less a hurry.

Don't forget to use Starling's Law to advantage when you sedate without fluids hanging. Starling is my friend.

Still have to find my calipers to comply with the latest safety warning about droperidol, went up on fda.gov on 12-05. Gosh I want to be inserviced on propofol.