Conscious sedation always used for angios?

NurseGirlKaren · Feb 9, 2003

It all depends on the doc/procedure/pt's comfort. Some of our docs always call out for sedation when they walk in the room; others just wait and see how the pt's doing. As long as the pt's comfortable, I'm ok with not giving them sedation. If the doc refuses to let them have sedation if they really needed it, then I would have a problem. For example, if a pt is known to have sleep apnea and is comfortable during the procedure, then I'd be happy to not give them sedation!

It all just depends on the circumstances. Hope this helps!

Editorial Team / Admin · Feb 9, 2003

Most of our caths and angios are done with mild sedation and local anesthesia, mild sedation being 1-2mg Versed at beginning of case, possibly with 25-50mcg Fentanyl added. Pts are generally very comfortable (we monitor them continually for comfort) during case. Our conscious sedation protocol, written by the anesthesia dept, stipulates that it becomes conscious sedation if we have to titrate doses to maintain a level of sedation required for the exam. Most cases we do try to stay with mild sedation. As NurseGirlKaren wrote, it does depend on the case and the pt as to what is used and how much. The cardiologist whose pts are uncomfortable may not be giving enough local anesthesia, or not over a wide enough area, or the pts may benefit from use of a longer-acting local anesthetic agent (eg, Marcaine). The one or two mg of Versed usually helps "take the edge off."

dspring, RN · Feb 14, 2003

I see both in out lab. Our Vascular Dr. and Cardiologist want them zonked, and our Rads give a little happy juice, and lots of Lido, and they get along just fine.

RadRN2 · Feb 17, 2003

We're about the same as everyone else here. Probably around 85% of our IR cases receive some Versed/Fentanyl combination, varies according to pt anxiety/pain/type and discomfort of procedure. Our rads pretty much leave it up to the RN's to give appropriate sedation/analgesia which is great because I think we have a much better feel for it during the case. Generally, the quicker diagnostic cases, especially neuro angios are lightly sedated so we can better moniter LOC. Longer, more painful procedures like PTC and vertebroplasty receive heavier doses. We also pre-dose our vertebroplasties with Toradol.

CCL"Babe", BSN, RN · Feb 17, 2003

We almost always do valium and sometimes dilaudid. We tried Versed, but our MDs didn't like the fact that patients didn't remember their procedures or what was said to them. A couple of times we had some patients wake up during long procedures with versed and try and get off the table. Only one MD uses versed routinely in combo with dilaudid. If our patients have a history of sleep apnea we get a bipap machine from resp therapy or ask the patient to bring in theirs. It is very rare that we don't sedate our patients. Most of them are pretty anxious when they hit our sheets.

RadRN2 · Feb 17, 2003

Now that's interesting -- we like Versed BECAUSE of the amnesiac effect! You're the first I've seen use Dilaudid routinely, is there specific reasons for that preference?

CCL"Babe", BSN, RN · Feb 17, 2003

We use dilaud usually for pain management, in small increments. We give dilaudid for chest pain during PTCA/stents and other invasive procedures. Many patients complain about the tables -back pain etc. Some people are just plain resistant to valium or versed, but a little bit of dilaudid puts them in a comfortable place. The one MD that uses Versed routinely always orders 1mgm of versed and 1mgm of dilaudid.

I think our MDs get tired of answering the same questions repeatedly after sedating the patients with Versed. Often the patients do not see the doctor again. We have PAs who follow the patients once they leave the lab. The patients didn't remember seeing the doctors after the procedures and would get pissed, demanding to see them.

When we do conscious sedation on any of our TEEs and cardioversions we do versed and Demerol. Usually in the lab we only give demerol for the shakes.

dspring, RN · Feb 18, 2003

Toradol preop for vertebroplasty? Have you seen much difference with it. Toradol is one of my favorite drugs for kidney stone pain. I've seen grown men cry with 10 of morphine, and give them 30 of toradol and boom they are ready to walk out the door.

RadRN2 · Feb 18, 2003

We have one guy who gives Toradol 30 mg pre-procedure and another one who gives the same only post-procedure. The "pre" guy does alot more vertebroplasties than the other one, but I do think his pts do better than the "post" Toradol.