Protocols for discharging patients who have sedation

girlsptz · Mar 6, 2005

nurses give the conscious sedation....Versed or Diazemuls for Gastro's and Fentanyl and Diazemuls for the Colon's. The patients are discharged 1 hour after they return to our recovery unit from their test and are stable. They have to had previously arranged a responsible adult that will drive them home. They are instructed that it is illegal to drive for the next 24 hours. It is very rare that anyone has to stay pass this 1 hour window.

Sandra

JEEMA · Mar 6, 2005

In the middle east (where I used to work), patients are usually sent home at the end of the day. We used to give them the antidote just to keep them awake and be ready for discharge. It was only when we experienced a complication after a colleague give two antidotes, narcan and flumazenil at short intervals that we kept giving them at the minimum:). Patient developed pulmonary edema after colonoscopy. She was fine after the procedure but started coughing frothy secretions after receiving the 2 antidotes.

It was late and we want to discharge the patient... but it turned out we have to stay longer than anticipated.

For out-patients who never respond to repeated doses of antidote, they are admitted for observation. Otherwise, those who have nobody to accompany them are advised to take a cab to reach home and come back in the evening to pick up their car.

I miss working in endoscopy...

Lucy2 · Apr 6, 2005

The unit I work in (New Zealand) we give Midazolam and Fentanyl, we normally keep patients 30mins to an hour after the procedure they must have someone to take them home and are not allowed to drive for 24 hours.

Kyli · Apr 21, 2005

I work in Australia. We use anaesthetists in our unit - whom administer propofol, midazolam and fentanyl.

Our outpatients are kept for at least an hour and a half and then discharged home. They have prearranged transport home, as they are not to drive until the next day.

The patient is also given a discharge pamphlet when they leave, with all the previously mentioned instructions such as not to drive, no alcohol for 24hrs, not to sign legal documents or make important decisions until the next day etc etc

mshultz · May 1, 2005

hello in the unit i work in in southern california we can discharge pts after being in recovery for 1/2 and their vital signs are within a normal range of their baseline. we also require pts to pass the air from the colonoscopy and have a soft non tender abdomen and to be able to swallow without and pain or difficulty after an egd. we use demerol and versed. usually the average does is 50mg demerol 3-4 mg of versed per pt. that is the average. sometimes less and sometimes more. we are also seeing a trend of pts (especially men) having a colonoscopy without and sedation. they leave after they pass the residual air from the procedure. a 24hr stay is excessive and versed is pretty much metabolized in about 20 mins. good luck! lisa

what techniques are used in order to make colonoscopy bearable without sedation? the techniques that i have read about include using a gastroenterologist with extensive experience and skill, the use of abdominal compression to prevent looping, and the olympus scopeguide, which transmits an image of its path through the colon, so that looping can be seen and prevented.

your post is the most encouraging yet about colonoscopy without sedation, since you say that it is becoming more popular. i was initially given 50mg demerol, and 1mg versed, since i wanted to watch. i asked for more drugs, probably when the scope was going from the transverse colon to the ascending colon, and was given 25mg demerol and 2mg versed. unfortunately, i was not able to remember the rest of the procedure.

when it is time for another colonoscopy, i will request it without sedation. this will probably mean going out of town, but as ohio is blessed with top-notch medical facilities, i doubt that i will have to go all the way to california.

michael e. shultz

[email protected]

"outside of a dog, a book is man's best friend. inside of a dog, it's too dark to read."

groucho marx

Long Term Care Columnist / Guide · May 1, 2005

Undergoing a colonoscopy without sedation is something that I wouldn't ever want to try.......no thanks, give me plenty of Versed and Fentanyl, and I'll take a cab home if I have to!

Our outpatient surgery department generally allows people to go home within an hour of their procedures as long as they're able to drink, void, ambulate, and have a 'responsible adult' to drive them home. (Unless, of course, they keep dropping their 02 sats like I did after my recent surgery, in which case you have to stay put until you're above 90% on room air...... :chuckle ) Patients also sign a paper explaining that they should not drive, operate machinery, make important decisions or sign legal papers for 24 hours after the procedure. (Yeah, I can just imagine driving the 20 miles to my attorney's office and having him draw up my living will with all those sedatives and a Percocet chaser swirling around in my bloodstream...... :uhoh3: )

Trauma Columnist · May 1, 2005

If I'm the patient, more sedation is better, lol! However, it is amazing the different practices throughout the world. Thanks everyone.

mshultz · May 1, 2005

As far as the time frame for my colonoscopy:

The procedure took about 30 minutes, I was in the recovery room another 30 minutes, and was back in the hospital room for an hour before being released. I was given the discharge instructions as I previously posted in this thread, but did not have to sign them.

Michael E. Shultz

[email protected]

"Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read."

Groucho Marx

CrohnieToo · Jul 1, 2005

Hey, Mike. Talk to your gastro about having your colonoscopy w/o sedation. Also: check out these two abstracts and give your gastro a copy.

A Study of Pain During Colonoscopy

http://www.e-health-questions.info/html/board/index.php/action=displaythread&forum=boweldisorders&id=12&realm=default

Why Colonoscopy Is More Difficult In Women

http://www.e-health-questions.info/html/board/index.php/action=displaythread&forum=boweldisorders&id=13&realm=default

From the Journal of The Royal College of Surgeons of Edinburgh, here's an article by a "teaching colonoscopist" that details the whole procedure, including some of the things that can go wrong. It's called, How I do it, by A. LESLIE and R.J.C. STEELE, University Department of Surgery and Molecular Oncology, Ninewells Hospital, Dundee DD1 9SY, U.K.

http://www.rcsed.ac.uk/journal/vol47_2/4720010.html

I have my colonoscopies w/o sedation. We do use 25 mg of Demerol and if my vagus nerve gets in a twit at the transverse colon/hepatic flexure and causes me to start dry heaving I'm given a little bit of Phenergan to "humor" that vagus nerve.

My gastro and I had some pretty "strenuous" debates about whether I would have sedation or anesthesia or nothing for my colonoscopies. She finally agreed only after reading the above two articles and undergoing both the upper and lower scope w/o sedation herself. Even then we had to compromise to reach agreement which is why I get the Demerol. She agreed with me that the upper scope is worse w/o sedation than the lower due to the gag reflex during the upper.

The Demerol provides analgesia but not the sedating/memory blocking effects.

monkeelouise · Sep 15, 2007

We discharge our patient from recovery when vital signs have returned to baseline, the patient is awake, alert, and able to assist in ADLs, ie:dress themselves. We have no specific recovery time, it is patient and situation specific, as every patient has different needs.

We discharge via w/c to auto, responsible adult with them to assume care (not a taxi driver). D/c instructions include no alcohol for 24 hrs, no driving, clause for narcotics being admin. re:workplace drug testing.

Patients are given and explained discharge criteria PRE procedure. Discharge criteria administered on admit.

CrohnieToo · Sep 15, 2007

Our Endo unit will not even take the patient to the dressing room to change unless they have an adult with them to drive them home. Prior to being taken to the dressing room they are given discharge instructions similar to those above and they must sign them prior to changing as well. Only after all that is taken care of is the patient taken to change into a gown and their IVs set, etc. The adult accompanying them is shown the waiting room and told if they leave to go to the cafeteria or to make a phone call they MUST advise the nurses' desk accordingly.