Versed and fentanyl for sedation

[patriot6]

They're a nursing student that's why

inb4 they post their MCAT percentiles

---

Members don't see this ad.

 

[PpfSuxTube]

They're a nursing student that's why

Something anyway.
Ca2s don't do many mac cases, and don't talk like that either. And care more about learning deeper pharm and path than asking about midaz/fent

 

[nimbus]

Yup. 22mg versed and 22 - 50mcg boluses of fent.

Just add pancuronium 10mg and that was a pretty typical cardiac anesthesia induction in the 1990s.

 

[lobelsteve]

Or go this route:

 

[pgg]

Or go this route:

That anesthesiologist is an idiot.

 

[Twiggidy]

If I'M doing the sedating, in my humble opinion, there's almost no reason for me to use Versed when I can accomplish what I need to do with propofol. I'll add fentanyl if I need actual pain control.

The big mistake I run into with proceduralist giving sedation and then calling us for rescue is that they treat movement and pain with "more versed" which is the incorrect drug. Versed does NOT provide pain relief and it also may not get someone as "asleep" as they want them

 

[deleted875186]

If I'M doing the sedating, in my humble opinion, there's almost no reason for me to use Versed when I can accomplish what I need to do with propofol. I'll add fentanyl if I need actual pain control.

The big mistake I run into with proceduralist giving sedation and then calling us for rescue is that they treat movement and pain with "more versed" which is the incorrect drug. Versed does NOT provide pain relief and it also may not get someone as "asleep" as they want them

I disagree somewhat. Movement should be treated with local. Even us giving more fentanyl, versed, propofol, or anything else, is just moving to deep sedation or GA, which is fine if you can manage the airway to keep the patient safe. But in general, I agree a higher opioid and lower dose benzonorbhyponotic tends to produce more immobility.

 

[Twiggidy]

I disagree somewhat. Movement should be treated with local. Even us giving more fentanyl, versed, propofol, or anything else, is just moving to deep sedation or GA, which is fine if you can manage the airway to keep the patient safe. But in general, I agree a higher opioid and lower dose benzonorbhyponotic tends to produce more immobility.

i agree with this as well and we actually recently had a problem with this with a new grad proceduralist dealing with someone who really didn't want to go to sleep (for whatever reason). she kept looking back and my colleague was basically like, "why are you being so cheap with the local?".....which brings me to another subject of how many proceduralist don't know the max dose of local they can use which drives me crazy.

 

[GassYous]

i agree with this as well and we actually recently had a problem with this with a new grad proceduralist dealing with someone who really didn't want to go to sleep (for whatever reason). she kept looking back and my colleague was basically like, "why are you being so cheap with the local?".....which brings me to another subject of how many proceduralist don't know the max dose of local they can use which drives me crazy.

I hate it when they give like 7 of local. Like how did you come up with that dosing and wtf?

 

[NumTacos]

My 82nd percentile on my Ca2 Ite would disagree with you. I'm asking a question among colleagues here. No reason to clown.

My man, you have so much to learn. Don’t brag about that stuff, it’s seriously cringe.

 

[coffeebythelake]

Or go this route:

Clownish

 

[medicine2wallstreet]

My man, you have so much to learn. Don’t brag about that stuff, it’s seriously cringe.

I asked the question of interest in here so I am obviously interested in learning. I was defending myself against a clown that told me I was a nurse. Not gonna apologize for that. And I wasn't bragging.

 

[NumTacos]

I asked the question of interest in here so I am obviously interested in learning. I was defending myself against a clown that told me I was a nurse. Not gonna apologize for that. And I wasn't bragging.

Get a tougher skin, you are going to need it. And yes, you were bragging. Although, 82% is not much to brag about.

 

[Twiggidy]

What are y'all's thoughts on the common practice and combination of versed and fentanyl for procedural sedation and Mac? This practice is incredibly pervasive in anesthesia. In my reading and understanding it seems like versed alone would be the much better agent as combining the two makes a patient much more prone to respiratory depression per benzodiazepine warnings. Yet we routinely give both. Is there any utility to fentanyl for minimal stimulation procedures aka less painful? I'm a resident currently but honestly I'm leaning towards only versed in my practice in the future given that respiratory events are the biggest closed claim in regards to Mac. I'm not spooked about getting sued is why I say that, just trying to find a way to perform tidier anesthesia. Or am I just imagining things that don't matter. Thanks.

You will find as you progress in practice that “MAC” procedures are more of an art than a science. As an anesthesiologist with more tools in my belt I’ve gone further away from midazolam and leaned heavier on propofol for my sedation procedures because it sedates and patients are less crazier when used correctly. But remember MAC is an art and it’s easy to hit a point of no return when you just have to do a general.

A lot of it is song and dance because proceduralist will ask for MAC but then they don’t want to talk to the patient and want them more asleep which is basically deep sedation/GA. A true Mac is very little drugs and only given up front with you providing “monitored anesthesia care”….I’ve seen a lot of charted “MAC” that was basically general