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.

Mersa59 said:
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

The problem with the sm bowel caps or pill cam as you call it is they can become lodged within the sm bowel, and if not passed the pt has to have surgery to remove!

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No, they had 0-2 there and a face mask and gave me some 0-2 while they were sedating me,I went out pretty quickly, did not wake up until the start of the colonoscopy. I was in and out during the colonoscopy.

I would wake up and feeling pain, moan or call out and then would fall back to sleep, only to wake up moaning again, the time frame between wake up times I can not tell you. I do not remember all of it, I did not feel all of it. Or "remember" feeling all of it. there were several times that I was aware of pain, and more awake. in comparrison to other times.

mersa

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we have given the pill cam to several patients on my unit no one had difficulty passing them. From what I read in the literature there is a very small percentage of patients who do not pass them, it was a miniscule amount. Like o.5 % or less.

you did not answer me about the push endoscopy?

mersa

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nurse baby girl 08,

one of my other memories I have was while moaning in pain and calling out, I remember trying to sit up and one of the nurses, placing her hands on my shoulders, trying to get me to lie back down and saying shhhh shhhh....

mersa

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Givens Imaging who developed the pill camera endoscopy has also developed the Agile Patency Capsule. This is a dissolvable pill the same size as the PCE. You swallow the pill one day and 26 hours later they either "scan" your abdomen w/a hand held device developed by Givens or they do an abdominal xray. If the APC is still present you are NOT a candidate for the PCE. The APC will dissolve w/in 3-4 days.

I first brought up the PCE w/my gastro before it was FDA approved in the hopes that I could get into a clinical trial. None were available at the time. I later realized I was not a particularly good candidate for it due to a high grade partial obstruction at my old resection site in the mid-ileum.

Recently my gastro advised me they were now doing the PCE in my area and strongly suggested I agree to one. I reminded her about the partial obstruction and told her I would NOT agree to one w/o doing the APC first. She said the only place in our area using the APC was a 2 hour drive. But she later called and said she could get the APC thru one of our local hospitals. I jumped at the chance. Unfortunately, as suspected the APC didn't pass, there it sat big and bold as life at the partial obstruction site on abdominal xray. *sigh*

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I haven't kept up on it since my area of interest is the small intestine, but last I knew Givens was close to FDA approval for either a pill camera upper endoscopy or a pill camera colonoscopy and working on the other.

The drawback is a PCE can't remove polyps, dilate strictures, cauterize bleeding, stretch the esophagus if needed, etc. But - the observations can determine whether any of the above procedures need to be done and certainly is a lot more pleasant than the scopes themselves. God bless Givens Imaging!!!

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Mersa59 said:
nurse baby girl 08,

one of my other memories I have was while moaning in pain and calling out, I remember trying to sit up and one of the nurses, placing her hands on my shoulders, trying to get me to lie back down and saying shhhh shhhh....

mersa

sorry so long to get back to you... i'm sorry about your experince.. that's awfull. When i sedate pt's i go slow with the sedation allowing "more time" for the medicine to work. No med will work properly if not given enough time to work. Not talking about all docs, but some what to insert the scope RIGHT after the first dose of meds are given.That can be less than 30 secs! it's the sedating nurse's responsiblity to tell the doc "wait, i'm not ready yet".

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monkeelouise said:
.....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.

I agree. I has an EGD a few months ago and was a little freaked. This is due to the fact that I had never had that type of procedure before. I had only had surgery where I was totally out (GA).

The pre-procedure nurse could tell that I was freaked. I mentioned surgery a few times, and at one point the nurse took my hand and explained to me how CS works and how it was different from GA. This time of explanation REALLY helped me a lot. I was a lot more calm after that.

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I have to have an endoscopy due to possible Barrett's esophogus. I'm an LPN student and graduate in December. After reading some of these, I'm terrified. The doc told me that "he will give me a few margaritas and tequilla" in an IV and I won't feel or remember a thing from the procedure. After reading these, I'm not so sure I want to have the procedure done. I haven't had anything done since I was 5 and that was a broken jaw repair. I don't remember that but I don't want to remember this either!

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Mindy, there is NOTHING painful about the upper endoscopy! NOTHING. IF you aren't "adequately sedated" the absolute WORST you will encounter is some strong gagging. And given the throat spray they use you might likely not even counter that or just mild gagging.

It is the lower scope, the colonoscopy, that CAN be painful if the scopist doesn't take his/her time and proceed slowly or gets too carried away w/the amount of air used to distend the colon to allow for easier passage of the scope.

AND! No nasty prep for the upper endoscopy!!! County your blessings! You're getting off easy w/just the endoscopy!! :lol:

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Mindy,

ask for propofol, I did not feel a thing or remember anything with mine, it was the colonoscopy that I was not sedated enough for.

mar

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CrohnieToo said:
Mindy, there is NOTHING painful about the upper endoscopy! NOTHING. IF you aren't "adequately sedated" the absolute WORST you will encounter is some strong gagging. And given the throat spray they use you might likely not even counter that or just mild gagging.

It is the lower scope, the colonoscopy, that CAN be painful if the scopist doesn't take his/her time and proceed slowly or gets too carried away w/the amount of air used to distend the colon to allow for easier passage of the scope.

AND! No nasty prep for the upper endoscopy!!! County your blessings! You're getting off easy w/just the endoscopy!! :lol:

THANKS!!! A TON!!!

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