I only give it if the patient is totally freaking out....and even then, I would probably give them 5cc's of propofol....gives me much more control.
I probably give it once every couple of months....if even."
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.
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.
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.
i've met/heard/read that people will give
it to everyone, regardless if they need it or
despite their age.
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.