Sedation/Analgesia

Question:

There is a shortage of fentanyl and versed and I am exploring alternatives for endoscopy. My thought is to try valium 10 mg IV 30 min prior to procedure then use morphine in 2.5 mg IV increments during the procedure. Or possibly dilaudid in 0.2 mg  IV increments. Any thoughts or experience with this?

Thanks
Ernie

WMR Replies:
 
Medicos recommends  2.5 mg increments of diazepam concurrently with the 25 mg increments of merperidine. Colonosocpy is started concurrently with the 2nd increment and we lose no time. EGD  takes 5-10 min before we are ready to go. Usually I am doing  paperwork in the Office OR , and no time is lost while the physician actively supervises the administration of these drugs.
 
Special issues---BUT, Surgical Family Medicine is vastly different than surgical GI endoscopy in that FP's are regularly uncovering previously undiagnosed issues such as latent alcoholism, anxiety neurosis, off label uses of xanax from the street, domestic abuse, etc. Then again there are the bipolar patients who must have their sedation/analgesia and recovery carefully tailored to their unique biochemistries.
 
 
What's your opinion on propofol?  Rapid onset, rapid recovery.  Easy to dose.  Low side effects.  Wide margin for "error".  I've begun to use it frequently for procedural sedation.

Omar L. Hamada, MD, FAAFP, FACOG, FICS
Vanderbilt MBA, 2012

 

WMR Replies:

Good drug whose reputation has been contaminated by the Michael Jackson case. What does it cost you to use it?

No idea.  :-) Mainly in ED.

Omar

WMR Replies:

Propofol and alternatives are discussed below. Note physician who uses it but does not have any idea of cost. We hope that physicians will find positions where they are vital to the review of efficacy, effectiveness, availalbility and cost.
 
The disconnect of physicians from cost is one of the reasons that we are skeptical of recommending common USA methods for our brothers and sisters in developing countries. At Medicos we are always asking if we should teach this method or another.
 
Propofol is a poster child for this dilemma. ESSURE is another problem child for international efforts. The tubal occlusion devices cost $1400 and the follow-up is incredibly difficult. Propofol is not something we would pack when travel restrictions limit the weight and space of supplies.
 
Science is one consideration, but cost and availability frequently cause us to teach methods which are adequate even when other methods are possible.

Index--GI endosocpy, sedation/analgesia, office anesthesia

Comments

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The disconnect of physicians from cost is one of the reasons that we are skeptical of recommending common USA methods for our brothers and sisters in developing countries. At Medicos we are always asking if we should teach this method or another.

Propofol is a poster child for this dilemma. ESSURE is another problem child for international efforts. The tubal occlusion devices cost $1400 and the follow-up is incredibly difficult. Propofol is not something we would pack when travel restrictions limit the weight and space