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Discussion

Max dose of Versed?

Had a patient last night who came from another ICU on Fentanyl 200mcg/hr and Versed 60mg/hr and was STILL awake. He was a young guy, drinks a lot according to his family, about a 1/5 of vodka per day. Had to chase around the residents because Versed doesn't really do much for someone who is in withdrawls and we can't put the guy on the CIWA protocol because he's intubated. Took me three hours to get Morphine/Ativan gtts ordered for this patient and let me tell you they worked TONS better than Fent/Versed. I ended up talking to the Senior resident and I told him, I wasn't comfortable with the patient being on 60mg/hr of Versed and neither was he. But I'm looking all through my books and online and can't find the max dose of Versed.

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TLS, everything online I could find mentions max dose of 15 mg for sedation.

We don't use versed on the floor, but lots and lots of Ativan.

OMG! I think we've had someone on about 40/hr, similar situation. I don't think there is a true "max" on the drug, but obviously, at that high of a dose, a different form of sedation should be considered!

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The LD50 of Versed is 825mg/kg, so it appears there is a lot of room for dosing. Just a suggestion if you are using something in that high of doses the physician/provider should consider using a different sedation medication that works on different receptors ie. Propofol, precedex, or ketamine (ketamine and propofol is a great mix. Using 1-2mg of ketamine per 10mg of propofol and then set your pump at the normal levels for using propofol sedation....the mix won't cause near the hemodynamic changes of using either alone and most of the time it will only cause minimal respiratory depression!).

http://www.medic8.com/medicines/Midazolam.html

I recently got to use Precedex on a patient for the first time, and I love it. Usually when this girl was having pain, she would wig out and 2 mg of morphine wouldn't touch her. With Precedex, the 2 mg actually did the trick.

I spoke with a pharmacy student doing research on Precedex and she says they are doing trials of dosing in periods longer than 24 hours... I hope they pan out because propofol has so many side affects, and it would be nice to have a 3rd option for sedation :)

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