Lingering effects of versed for peds?

  1. I work out patient surgery so were talking minor surgical procedures on basically healthy pediatric patients.

    For the sake of argument we will be magical nurses and KNOW the child is not in pain or having other medical issues in PACU.

    Some nurses blame versed given in pre-op or OR if the pediatric patient is cranky, crying, inconsolable, acting out, in recovery. We do let parents back as soon as possible, this can happen even with parents there. The nurses think versed makes the child feel more disoriented, out of it "yucky". They hint to anesthesia that they don't like pediatric patients to get versed.

    It is not automatically given to every pediatric patient, depends on the child, the case, etc.

    Any thoughts?
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    About brownbook

    Joined: Jul '06; Posts: 2,657; Likes: 5,734
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  3. by   GHGoonette
    There are so many different drugs, and combinations of drugs, that can cause this. Certain kids don't react kindly to the volatile liquids, like Sevofluorane - in fact I'd be more inclined to look at that as the possible culprit - while others get a Midazolam (Versed) premed and are swinging from the chandeliers preop, and have a major comedown in recovery. Then there's Ketamine, an amazing anaesthetic agent with good analgesic properties, but if the patient goes on a bad trip under its effect, you can expect some over-the-top behavior.

    At the end of the day, neither you nor the other nurses can dictate what shall and shall not be given either as premed or intra-operatively; that is according to the anaesthesia provider's preference. What you can do, however, is request management to speak to the anaesthetists and request them to try out different cocktails. That way you may be able to isolate the guilty party.
  4. by   brownbook
    Thanks I have been getting so many reasoned, rational, responses from Allnurses lately. Some of the post get so crazy I sometimes despair of nurses listening, reading, and giving helpful responses to their fellow nurses.
  5. by   GHGoonette
    Quote from brownbook
    Thanks I have been getting so many reasoned, rational, responses from Allnurses lately. Some of the post get so crazy I sometimes despair of nurses listening, reading, and giving helpful responses to their fellow nurses.
    Surely not in the PACU forum? I know you can get some nasty ones in the general forum, but I don't think any of us are nasty here... Some people just don't like opposing views to their own. I've been flamed for taking a radically different stance from the other nurses, and a lot of the problem is, as you state, people not taking the trouble to read posts carefully enough.
  6. by   brownbook
    Well of course never in the PACU forum, ha ha.
  7. by   azhiker96
    I've never had a problem with versed in the peds. I agree that the likely culprit is sevo. If the child sleeps for awhile 20-30 minutes after the end of surgery they usually don't act up. I've often used a small dose of meperidine which helps them sleep while their body blows off the sevo. For parents who are worried, I explain that the anesthesia makes the child feel strange and that children don't understand or like that feeling. All the child knows is that they don't feel right and they have to let us know. I explain that we are just seeing the anesthesia and that their child will return after a bit. That seems to help the parents who are worried.

    Here's another thread on the subject. Sevo psychosis
  8. by   brownbook
    Thanks to you both. For my own curiosities sake I think I will start checking what anesthesia these kids get. I honestly don't know how often they use sevo for minor procedures? Some just get propofol.

    This is all just vague anecdotal talk from nurses. I prefer evidence based facts, not anecdotes!!

    We do tell parents in pre-op that kids wake up "cranky" this is just an unfortunate but common effect of anesthesia. But some co-workers seem to want to blame it all on versed?

    We just do kids from time to time. We are not a pediatric surgical center. But still I think I will start tracking these peds cases!
  9. by   GHGoonette
    Some of our anaesthetists use a combination, inducting with sevo, then maintaining with propofol and fentanyl. The cranky ones have always been inducted with sevo.

    I spoke to one of the younger guys yesterday, asking if he'd ever come across a tendency for kids to react badly to Midazolam post op, but he said he's never had a problem with it. However, I know his technique, and he always gives fentanyl and propofol intra-operatively, while the midazolam is prescribed as a premed. His paeds patients are usually very relaxed post-op.
  10. by   lady constance
    desflour is just as bad as sevo...especially with kids who have disabilities....

    doing this for years , and sadly, since we are talking about different personality/temperament in people in general.... nurses often use their 7th sense to evaluate and make notes what the patient had...and make a judgement call...i know of no research team that has come up with an adequate assessment tool to quantify and qualify and draw correct conclusions to what is noted immediately in the post op period based on what was received.. nor do i know any anesthesia person willing to only give the specific meds the study wants to watch---they want to be able to use their judgement to decide what to give and, unless we are thnking about a SS or tuskaheggee experiment, i am pretty sure we are stuck culminating years of expereinced nurses, and culling their "data" of what they saw and noted--and hope they correlate correctly cause and effect...

    some kids who are hades on wheels pre op are wonderfully sedate and actually pleasant....
    some kids who are pleasant and cooperative become WORMS ON A hot sidewalk effect.. log rolling and moving ( then again, so do adults!!)

    some times i take a bit of heat for quickly sedating patients waking up wild.. they seem to wake up mid dream, mid reccollection of some wretched memory and need to go back to sleep and wake up in a happier memory....but it has not ever failed me in 18 years.....and is a tecnique used often...
  11. by   ShannonRN2010
    Every child that we see gets versed and a fair share have sevo. That being said, some kids act better than others.
    I keep hearing that how a kid goes to sleep is how they wake up...
    I have learned (in 5 short months) to expect the unexpected with kids...

    I hate kid's day BTW.
  12. by   rnsrgr8t
    I do not work in the PACU but a lot our patients we see in clinic have conscious sedation for studies (VCUG's or need sedation for MRI's, scans etc). They routinely use versed/ketamine. I have seen some kids come out of it irritable and inconsolable, cryng. These kids should not have pain as they did not have surgery. I do not think there is any rhyme or reason who is going to wake up mad. I tell parents that they either wake up happy and are drunk and entertaining or they wake up really pi***d and irritable. I think that happens with any type of sedation/anesthesia. I remember when my mom had her endoscopy....she got Versed and woke up being very mean and nasty. She was acting so lucid that my Dad (an anesthesiologist) was SO angry at her for her behavior.... and she has NO memory of it. It was all the versed. The next day she was asking my dad why he was so angry at her. When he told her it was because of her behavior in the recovery room, she was like what???? I do not even remember BEING in the recovery room!
  13. by   OkieeRN
    It is really agreed upon in my peds PACU that versed is not our friend! But honestly, I think its a crap chute. Some kiddos wake up crazy and others are nice and calm. You learn to appreciate the calm ones.

    Someone mentioned ketamine in a previous post... I hate ketamine. I have seen little ones scared out of their minds from that stuff in recovery. Poor kiddos.
  14. by   wtbcrna
    There are lots of reasons for emergence delirium, if there was one drug that we could easily eliminate emergence delirium we would have stopped using it years ago.

    Here is good article discussing the various reasons for emergence delirium.