Curious about sedation

[AnewerRN]

I work on a busy tele unit and often recieve patients back from procedure (cath, pacer placement, egd/colo, etc.) who have recieved some amount of conscious sedation. My question is what is the usual dosage for these medications (i.e. fentynl, versed). I know this varies with patient weight/tolerance. I am just curious as to what doses you find yourself administering and over what period of time (if IVP is it back to back)? Thanks in advance!

[diane227, LPN, RN]

It is variable according to patient condition, weight and tolerance of medication. However, the issue that you should be concerned with is the ongoing assessment required after a con sed procedure. Your hospital should have a policy in place addressing con sed and the parameters required for repeat assessment and the criteria that must be met before that ongoing monitoring can be stopped. Anesthesia has a scoring system that they use (I can't remember what it is called now) but the recovery and day surgery unit in your hospital will have this and you can get a copy from them.

[GHGoonette, BSN, RN]

It is variable according to patient condition, weight and tolerance of medication. However, the issue that you should be concerned with is the ongoing assessment required after a con sed procedure. Your hospital should have a policy in place addressing con sed and the parameters required for repeat assessment and the criteria that must be met before that ongoing monitoring can be stopped. Anesthesia has a scoring system that they use (I can't remember what it is called now) but the recovery and day surgery unit in your hospital will have this and you can get a copy from them.

I presume you mean the Aldrete score, but the Glasgow coma scale may also be used, and may even be more appropriate in conscious sedation.

One of the components of Aldrete is assessment of reversal of neuro muscular blockers, which aren't used in conscious sedation.

[LBNM330]

If an anesthesia provider is involved they are most likely using propofol otherwise the nurse is administering Versed and Fentanyl. Probably around 2 to 4mg of versed, 2 mcg of fentanyl. They are both short acting.

[StephRN08]

It is very individualized and based on anesthesia's assessment. We get a lot of interventional radiology patients post-procedure and the RN's administer the sedation in that department - they most often (80% of the time) give Fentanyl 50 mcg and Versed 2 mg.

[shoegalRN, RN]

I work in the GI Lab PRN and I usually recover pts from EGD's/colonoscopies/ERCP's/EUS's, etc. For sedation, our docs normally use about 1-6 mg of Versed depending on the pt and about 25-100 mcgs of Fent depending on the pt. If the pt is still not sedated enough, they may throw in some Valium about 10-20 mg, and some Benadryl usually 25-50 mg. I usually recover these pts in about 30-45 minutes and then send them back to the floor.

For anesthesia pts, the docs usually use Propofol anywhere from 100-300 mg, sometimes more if the pt has a history of drug use. Sometimes they will throw in some Ketamine too. For these pts I usually recover them in one hour and send them back to the floor.

As soon as the pts are awake and it's cleared by the doc, they get an apple juice to get right up. Alot of times when they get back to the floor they usually sleep for a while.

[dreamingofbeing]

I work in Interventional Radiology and our most common dose is 100 mcg of Fentanyl and 1 mg of Versed. This varies depending on the patient and I have administered anywhere from 25-300 mcg of Fentanyl and 0.25-4 mg of Versed throughout a procedure. We use the Aldrete scale before and after procedures to judge our continued monitoring of the patient.

[wtbcrna, MSN, DNP, CRNA]

I presume you mean the Aldrete score, but the Glasgow coma scale may also be used, and may even be more appropriate in conscious sedation.

One of the components of Aldrete is assessment of reversal of neuro muscular blockers, which aren't used in conscious sedation.

There is nothing on the Aldrete score that directly relates to reversal of neurmuscular blockers. Movement is scored, but a deeply anesthetized/sedated patient doesn't move either. There is nothing in the alderete score that would help you directly determine reversal of neuromuscular blockers.

[wtbcrna, MSN, DNP, CRNA]

Sedation is so patient specific it is hard to give a good normal range, but for most procedures that aren't too stimulating I start with 1-2mg of Versed, then give 25-50mcg of fentanyl until the desired analgesic effect is achieved while titrating in more Versed as needed. That is when I don't use straight propofol that is.

I don't recommend using long acting medications such as benadryl or especially Valium for short procedures. Patients can have measurable cognitive dysfunction for weeks to months after sedation/anesthesia so it is best to use medications that are short acting if possible and to titrate to effect.

[syckRN]

I believe that the standard of care is not to deliver a patient to the floor until they meet certain LOC and VS criteria. Thus, it shouldn't be too important how much they received since, as everyone else has said, that is on an individual basis and can be based on patient tolerance and pain threshold. Fentanyl has a short half-life and that is why they use it. Versed can be reversed by romazicon if need be (but cautiously since reversal can cause seizures)

[wtbcrna, MSN, DNP, CRNA]

I believe that the standard of care is not to deliver a patient to the floor until they meet certain LOC and VS criteria. Thus, it shouldn't be too important how much they received since, as everyone else has said, that is on an individual basis and can be based on patient tolerance and pain threshold. Fentanyl has a short half-life and that is why they use it. Versed can be reversed by romazicon if need be (but cautiously since reversal can cause seizures)

Using romazicon to reverse Versed is not a good idea and in general means that your patient needs to be watched in PACU or 1:1 for another 2 hrs minimum. Romazicon's half-life is about 1hr where Versed's half-life is around 3hrs, so your patient can actually become resedated since the reversal is actually shorter than the agent. This is the same problem that happens when using narcan to reverse narcotics. It takes approximately 5 half-lives for a medication to completely clear the system.

The half-life of valium is 20-50hrs.

[CCL RN, RN]

For caths, we start with 2 versed and 50 fentanyl. Then go with 1/25 increments from there until the pt is at desired sedation.

Like others have mentioned, it all depends on the pt. I've seen grown men take 1/25 and be sedated as all get out, and little ol' ladies require 8/200 plus benedryl! Alcoholics are notorious for requiring a lot more sedation (in my experiences).