Average doseage of conscious sedation while doing endoscopy's

Specialties Gastroenterology

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I am interested in the average dose of conscious sedation that Endo nurses are giving. We use demerol and versed at my hospital and feel that several of our doctors need more education on conscious sedation but have no numbers to get an average dose of medicaiton. Any info is appreciated.

I have my EGDs w/o sedation/analgesia except for the throat spray at my insistence. The only difficult part is the gagging. There is no pain. The gagging is no fun but watching the monitor and seeing for myself makes up for it.

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I'm new here, about to have en endo and a colo same day for the first time. Problem is I've been taking versed (oral) 15 mg to sleep every night for the last 5 years (where I live is legal and I do have an rx). Would it be better skip this kind of sedation and go directly to propofol?

thanks

Mo

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mshultz said:
I really appreciate your informative posts. You and another poster mention having bad reactions to Versed (referring to your first link). Although I have searched this site for days, I can not find the post I want. Anyway, as I recall, the poster explained that since Versed has no analgesic properties and reduces inhibitions, abusive behavior is to be expected when there is inadequate pain relief. Maybe one of the CRNAs or AAs will see this post and respond.

Michael

"Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read."

Groucho Marx

Thank you, Michael. I've only related my own experiences which is limited as I don't work an Endo department. And so much relies upon the gastro or doctor doing the scope and if they are willing to take the time to advance the scope slowly and sensitive to scope looping. We have a gastro and a colorectal who like to race to see who gets thru their procedures fastest.

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Specializes in Med-Surg,Critical Care, Radiology,GI.

I read through all of the replies on this site. I am an old endo murse, 10 years, I have sedated all types of patients. The endo lab I work in is hospital-base with inpatient and outpatient procedures. We handle all types of endo cases, except EUS.

We are nurses, that these patients come to endo, put their trust in to care for them, sedate them, and protect their best interest as WE are the ones that put these patients in a VULNERABLE state.

WE ARE THE PATIENT ADVOCATE! Speak up, Demand that the patient be sedated adequately and document those requests. MDs respond very well when they see your documentation and how it reflects upon them.

Jewels:Benadryl 25 mg SIVP works wonders in assisting sedation for patients that take antidepressant meds, and are on a pain management program. These medications partially block the nerve receptor sites that Versed and Fentanyl or Demerol access. Therefore the meds don't work for these types of patients as effectivly as on others.

There was some responses to a person being "fat", and not having enough sedation, and if memory serves, Demerol was used during the colon scope. We have seen that Demerol does not effectivly sedate someone with a large amount of adipose tissue, reponse to sedation is slowed, and recovery is longer. A 300 lb man that is mostly muscle will sedate quite faster and with less meds that a 300lb woman that is 5 ft tall. I am sorry for the this person's bad experience, I, personally, would find a different MD, and suggest GA for your next endoscope.

There were many reponses that stated the patient pre-procedure was under the impression that they would be "knocked out". We have found that people ask friends and family about their endo experiences and well meaning nursing friends that are unfortunately uninformed about CS and come away with this very wrong expectation. PRE-PROCEDURE PATIENT TEACHING IS CRUCIAL! Take the extra 5 minutes to explain CS to your patient, what they may experience. Anxiety levels and patient complaints are reduced by that little something extra.

These patients remember the extra time, smiles, and care that we give them. Their experience with their MD or endoscope may not be thought of fondly, but, they will return for another procedure based on the care WE give them.

Okay, I'm off my soapbox for now, God bless.

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I know this article is old. However I need to comment.

Droperidol is Inapsine, and Antipsychotic medication.

we used it in the past for out of control patients. It is now black boxed, I thought, and no longer used in psychiatry. there have been deaths related to its use.

It is a chemical restraint, not a drug that I would think should be used for an EGD or colonoscopy. I was appalled to read this..

I am an R.N. also.

Mersa

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robrn said:
We use propofol for sedation and our MD's guarantee a painless procedure. To this date we have had no complaints, from our patients. We start with 30 to 50 milligrams of propofol then give incremental doses of 10 to 20 milligrams depending on the patient's response. Propofol is very predictable fast acting and rapidly dissipating. I have found Versed and Fentynl doses are all over the map, depending on the patient's previous exposure to benzos and narcotics.

I had Prpofol, while it was great for my EGD, I felt absolutely nothing, I was totaly out. For my Colonoscopy , immediately after the EGD it was not what I expected. I was told I would feel nothing and be out.

I felt the insertion of the colonscope, and every push for ward of that scope around the bends.

I had pain, was moaning and remember moaning and yelling out Owe !!Owe!! Owe!! I also felt the removal of the scope.

and had alot of discomfort and pain for a week -10 days after ward. I felt like a horse had kicked me. I have had C-sections and little pain meds after ward. a dislocated shoulder and so on. I am not a wimp to pain....but the propofol did not sedate me well enough for the colonoscopy, and I was angry as my thinking was that I had been lied too.

the nursing staff were very accomidating, but again , I felt like I had been lied to about this, as I asked many questions and stated my knowledge of the proceedure and what others had told me they experienced.

so while Propofol is better it is not something that sedates enough to keep you totaly unaware of pain, discomfort and what is going on.

mersa

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Well said, Monkeelouise!

Mersa, it may well have been that you are one who doesn't respond as well and as quickly to propofol or may need a "heavier" dose for you size than many. It may well have been the person administering it was cautious due to you vitals or even that it would have been better had the EGD been done first before the colonoscopy. For sure, your doctor doing the scope was neither particularly skilled or conscientious of his/her patients or you would not have experienced the lingering discomfort after the procedure. The ONLY time I ever felt that "kicked in the stomach" feeling after a colonoscopy was my first scope when I reacted to the Versed and got agitated and hostile resulting in an incomplete as my gastro had to w/draw the scope w/nurses holding me down and a barium enema series the following day in the scope's stead.

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cHRONIETOO

the egd was done first. I felt nothing , I was totaly out...had propofol for that..........however ....when it was time for the colonoscopy, which was "after" the egd.....I woke up, and woke up several times thru out the proceedure as I mentioned.

so if I was sedated enough for the egd, I should have been sedated enough for the colonoscopy. They lightened up on the dose of propofol for the colonoscopy was my guess.my VS were ok thru out.

Mersa

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Propofol is a SHORT ACTING general anesthetic. It is NOT "conscious sedation".

Propofol dosing and titration is variable, based on the patient's tolerance to the drug. Profound changes can occur rapidly. A patient can go from breathing normally to a full respiratory arrest in seconds, even at low doses, without warning from typical assessment parameters. There is no reversal agent. Unlike other sedation agents such as Versed there is no reversal agent for propofol. Adverse effects must be treated until the drug is metabolized.

EGD is usually done before colonoscopy. All I was suggesting was that perhaps the results for you would have been better had the colonoscopy been done first. There is no pain w/the usual EDG just bad gagging. I've had both scopes done w/o "sedation" at my insistence.

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No thanks, I did not want to feel anything with either scope. If i would have had bad gagging, I would of done all I could to stop the proceedure.It is my understanding, now, that women have more discomfort with colonoscopy, and there is a higher chance of pain, when you have had abdominal surgery.. I had 3 C-sections in the past.

so this may have contributed.

However on many other sites, with patient accounts, many women, complain about the painful experience of colonoscopy. I would think this needs to be addressed better, and there needs to be better pain management.....that colonscope is huge,long, and the adult scope looks like a dern water hose.

just my opinion and experience.

Mersa

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CrohnieToo

have you assisted in Push endoscopy?

where they go as far into the small bowel as they can?

What are you giving for sedation with that?

I know they are doing more Pill Cam endoscopies now, as they say the Push endoscopy has more pain and discomfort with it, and there are higher risks involved secondary to the nature of the small bowel.

more twist and turns, and it moves more easily when the scope is trying to be advanced.

thanks for your input.

Mersa

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Mersa59 said:
cHRONIETOO

the egd was done first. I felt nothing , I was totaly out...had propofol for that..........however ....when it was time for the colonoscopy, which was "after" the egd.....I woke up, and woke up several times thru out the proceedure as I mentioned.

so if I was sedated enough for the egd, I should have been sedated enough for the colonoscopy. They lightened up on the dose of propofol for the colonoscopy was my guess.my VS were ok thru out.

Mersa

Mersa were you ventilated during this procedure?

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