lotsa fentanyl, no sleepy

[elizabells, BSN, RN]

So, just a question after the fact..... I had an upper endo the other day, and I got 75 fentanyl and I believe 6-8 of Versed IV in three pushes. All that happened was I sort of didn't care that they were shoving a tube down my throat. The dr and nurse seemed sort of surprised that nothing was going on, and the nurse actually questioned the final 25 of fent, but gave it anyway. I weigh 125 lb and already had 0.5 mg Klonopin on board. I'm just a student, so if this is normal, forgive me, but that seems like rather a lot given that I felt almost no effects. Thoughts?

I'm asking this only educationally, by the way...I don't know a whole lot about pharm.

[avado, BSN]

fentanyl is to make you comfortable as in pain med and versed so you don't remember the procedure. I had seen versed given to a pt and she did not sleep but talked normally but a bit goofy and when it wore off she felt like she slept. I swore when I got it (versed)for wisdom tooth removal that I slept but now I kinda hope I wasn't talking up a storm. lol

[sjb2005]

Wow,

All I can say is that I had versed for 2 procedures. Maybe fentanyl to. Don't remember a thing with either one. My kind of tests. I just hope I didn't say anything to my fellow colleges I might regret if I knew what it was. Wide awake afterwards.

[AlexCCRN]

Pts response to narcs is variable. Issues of tolerance and cross-tolerance may play a part. Paradoxical reactions to Versed are not uncommon. Maybe you weren't getting *all* the analgesic that was reported? Who knows. Chalk it up to learning first hand that some pts are actually telling the truth when they say they need more :)

[athomas91]

what other meds do you take (on a daily basis)

[elizabells, BSN, RN]

what other meds do you take (on a daily basis)

lexapro, abilify, inderal, and klonopin. I think I'm probably pretty tolerant to relaxants! I did sleep for the rest of the afternoon after I got home, just not during the procedure. Oh, and my BP went down to 87/56 at one point, but I do take propranolol.

[athomas91]

because of your med regimen you are likely able to tolerate much more than someone who isn't on any meds could. sounds like they gave you just the right amount!

[elizabells, BSN, RN]

because of your med regimen you are likely able to tolerate much more than someone who isn't on any meds could. sounds like they gave you just the right amount!

I figured it was something like that. I'm sort of glad I was awake so I could watch on the monitor, actually!

[Nitecap]

75mcg of fent isnt that much, though the versed dose was generous. Maybe your IV was infiltrated, so you got the meds slower. Might explain why you went home and slept all day. I have had plenty IV do the same, I get mod by bldy return and no resistance to push, but later you find out it was infiltrated the whole damn time and you know have a ton of meds SQ and in the tissues slowly diffusing in. This was in ICU.

[rjflyn, ASN, RN]

Considering per Epocates that the dose range for Fentynal -anesthesia adjunct is 2-50mcg/kg is say you definately got a low dose.

Sounds to me like you didnt get enough. I had an endoscopy a few years ago and I only recall getting the meds, getting the hurricaine spray, making a comment that it tasted like s--t and that I hope the scope doesnt too and then waking up about an hour later.

RJ

[athomas91]

if she was comfortable - she had just the right amt of medication - con. sedation is just that - you are sedated but awake and able to follow commands.

[gasgiver]

What you must realize is that 25-50mcq is per dose and you can give more than one dose. 75mcg is 1.5cc, that is plenty for an endo case. As said earlier, if you were comfortable than you had the right amount. Conscious sedation is just that, conscious..... You have to maintain your own airway....