ERCPs, EUSs and sedation

Nurses in our unit administer Versed, Fentanyl, and Valium for these procedures and we've found that atleast 50% of these procedure patients are inadequately sedated, no matter the dosages used. These are patients that are diaphoretic, need restraint during the procedures and become tachycardic with hypertension. We simply can't get them to a good level of sedation for a safe procedure.

Please let me know what your units are doing. Do you experience the same? Are you using propofol instead (by anesthesiology)? Are you using a different combination of drugs that provides a safe procedure?

At my hospital the doc who does EUS'S uses Demerol and Versed and I have not really had a problem. As for ERCP's I have done them with Fentanyl /Versed, Demerol/Vresed and Fentanyl/Valium I have had both good and bad experiences, some docs do use anesthesia dept who does them under general anesthesia. If I was having an ERCP I would have it that way.

Where I work the CRNA's and Anesthesiologist are using propofol, with little versed and fentanly. It works great, the people are out like lights and wake up and recover quite quickly. We used to use the Versed/Demerol route but to adequately sedate a pt, you'd have to seriously snow them and then recovery was greatly extended.

I had two ERCP's last month and during the first one I woke up 2 times during the procedure. I don't remember discomfort only the nurse saying "it's almost finished". During the second procedure I didn't awaken during the procedure. I vomited after the first one but felt wide awake and ok after the 2nd one. I know one of the drugs was Fentanyl but can't remember what else was used.

Most of our GI docs routinely use propofol on our unit. The ones that don't want it get fentanyl and versed, sometimes phenergan. ERCP's and EUS's are particularly difficult without propofol.

I've worked in a GI Unit here in Florida for almost 3 years. We only use Moderation Sedation (mostly Versed, Fentanyl, Demerol) when anesthesia is not available--otherwise all patients receive Diprivan. Our doc who does EUSs ALWAYS has his patients receive general anesthesia for uppers (he fills the stomach with water, so general provides airway protection), and Diprivan for lowers. ERCPs ALWAYS receive general as well.