Sunday, June 13, 2010

I don't hate all CRNA's

I don't hate them all... Just the ones who can't do their job without Versed. Here is a collection of CRNA's and their posts on Nurse Anesthetist (CRNA) Forums - Powered by vBulletin which I have respect for. This is from an old discussion about their (alarming) Versed use... nearly 60% of these nurses routinely give everybody Versed. Preoperative use of Versed - Nurse Anesthetist (CRNA) Forums As usual the bold face italics are my own.

Re: Preoperative use of Versed

"I was trained to give it to just about everyone...2mg versed. It was almost a habit. However, I have found that it doesnt always work. If the patients drinks at all that 2mg of versed isnt going to work as far as amnesia is concerned.

I only give it if the patient is totally freaking out....and even then, I would probably give them 5cc's of me much more control.

I probably give it once every couple of months....if even."
Thank you! This person gets it and has curtailed their use of Versed in spite of their habit forming training. By the way I don't drink and the Versed amnesia didn't work on me. Thank God. I think it has more to do with high IQ, rather than an alcohol consumption from my limited experience with people who have had a bad reaction. It's alarming how many high functioning engineer and professional people are reacting to the assault on their cognitive function in the same way.

Re: Preoperative use of Versed

I dont 'always' give it.

There are many pts who I feel it might be a risk to give it to. Im thinking specifically about the elderly who have a crap load of pre-morbid conditions and are ASA 3-4s. Some wont get it at all, some ill wait and give it to in the OR, maybe 1 mg or even 0.5.

I go by the mantra "i can always give more" with these pts.

Sometimes, i dont give it b/c the pt dosent appear to 'need' it. Couple recent pts were not at all anxious, easy going and when i asked them if they wanted anything for nerves they said 'no'. To me, they dont need it.

I often wonder if i should be giving versed to everyone at least after induction to avoid any memory (ante-grade amnesia). However, in reading about it, seems only 40-60% of pts who get versed (in any setting) have amnesia at all. So it isnt reliable.

I have seen some pts get 2 mg of versed and 'dump' right there in front of me with severe hypoension. Also seen some become obtunded and obstruct from low doses. I guess im very cautious with what i perceive as a very dangerous drug. "go low give slow" in what ive been taught with versed!

Thanks Mike. I admire your attitude.
Re: Preoperative use of Versed

I'm with you mike. My thoughts exactly so I won't retype everything you just said. I was interested in hearing about people's ideas of using preoperative versed as it relates to anesthesia awareness.

I am a clinical preceptor where I work and I've been encouraging students to use their judgment when it comes to preoperative sedation with versed. Many students are very surprise by this notion
b/c they have been trained that just about everyone gets versed.
Students are surprise that I even ask patients if they want it or not.
I also try to consider the type of case, if the patient will be going home afterwards or staying. I try to avoid versed, if the patient doesn't need it and will be up and about after a simple procedure like
Egg retrieval, D&C, Carpal Tunnel Release, etc.

You are a professional, unlike those which I try to debase on this blog.

Re: Preoperative use of Versed

Originally Posted by infidel
Above .. about the age of 65 I look at the person a bit closer than under that age. I have seen elderly decompensate with Versed and get squirrely on the way back to the OR.
agree, that's why i was asking.
i've met/heard/read that people will give
it to everyone, regardless if they need it
despite their age.
This is absolutely true. Thanks for agreeing that this dangerous, unpredictable drug isn't for "everyone." You have my respect as well.
Re: Preoperative use of Versed

Some get predicated with anxiolytics (typically Versed), some do not. If I perceive that they need it or want it, then I typically get somewhat heavy handed if they are young and healthy (around 5mg of Versed; I have given more) and I will be at their side continuously before we go to the OR. If they are elderly or with significant comorbidities, I simply titrate the Versed to effect. Like Jan, I also rely on Zantac and Reglan.

I do not routinely give anxiolytics preoperatively as I feel I get a lot of mileage out of just talking to the patient and being at his/her side. It is interesting to see the variations in practices.
This is so nice to read. Thank you for thinking that it is better to TALK to us and be with us rather than taking the easy way out and drugging us. You are ABSOLUTELY CORRECT!
Re: Preoperative use of Versed

I rarely use versed unless I feel the patient truely has anxiety. I believe I can give a larger dose of narcotic with less respiratory depression when I do this. Also, althought I know it is not scientific, I have been told by the PACU nurses my patients seem to awake more quickly. A 1.5 - 3.0 hour half life is not long when you are doing a 6 hour case, but if your case is only 1.5 hours and you give 5 mg, it only stands to reason that you patient will be more sedated in the PACU. They still have 2.5 mg of versed on board, right?
This is excellent Jeff! Thank you for voicing what I am saying on my blog. I am correct in thinking that most people would rather have pain relief than some kind of zombie drug, ESPECIALLY if they do not have out of control anxiety. It's my opinion that slight anxiety would be "normal" in a medical situation and doesn't need something as hairy as Versed.
So there you have it. I don't hate all Dr.s, CRNA's, nurses etc. at all. Quite rightly I like and respect those who have a REASONED approach to their job, with the understanding that they are working with real people, not crash car dummies. Also, I have to say that standing up to armygas with his pathology makes me respect your backbone as well. Many thanks people.

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