po sedation procedures

[smarterchild]

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Hey all,

I was just curious how you all handle oral sedation for the very nervous patients?

what do you typically prescribe and how do you instruct the patients to take it?

do you have patient sign consent form at the time of the office visit or when they come in for the injection?

I’m in an office based setting so can’t really do IV sedation.

thanks!

 

[SommeRiver]

Valium 2-5mg

Many ways to do it - If super anxious do 5mg 90 min prior and 5mg 30 min prior.

I'll do two 2mg tabs 60-90 min prior and 2mg 30 min prior.

5mg 30 min prior.

Most common is 5mg 30-45mg prior.

 

[lobelsteve]

About 1/5 kypho in office, but would offer for scs or even rf. And mri if they ask.
Ativan 1mg #2. When you leave your house and if you need second one then on arrival to office. Needs a driver.

 

[lonelobo]

Hey all,

I was just curious how you all handle oral sedation for the very nervous patients?

what do you typically prescribe and how do you instruct the patients to take it?

do you have patient sign consent form at the time of the office visit or when they come in for the injection?

I’m in an office based setting so can’t really do IV sedation.

thanks!

Why can't you do IV sedation in office ?
Several years ago I did, but then over time transitioned out of using IV sedation for cases.
That being said many still perform in office and it pays well in some cases.

 

[BobBarker]

Nitrous. Charge them cash. No driver needed.

 

[paindoc007]

PO versed, 5-10 mg 30 min prior to procedure.

 

[smarterchild]

Thanks for all the helpful responses!

lonelobo, correct me if I’m wrong, but I thought in order for me to administer sedation, I needed an RN present.Being a small practice, I just have an MA working with me

how do you handle consent signing? Do it at the office visit before the procedure?

thanks!!

 

[Ligament]

Xanax 1-2 mg PO and
Phenergan 25mg PO

 

[lonelobo]

Thanks for all the helpful responses!

lonelobo, correct me if I’m wrong, but I thought in order for me to administer sedation, I needed an RN present.Being a small practice, I just have an MA working with me

how do you handle consent signing? Do it at the office visit before the procedure?

thanks!!

May be state dependent, we are allowed to have MA's start IVs here

Consents signed anytime prior to sedation

 

[manowar rules]

Nitrous. Charge them cash. No driver needed.

Interesting. Obviously dentists do this but I haven't considered this for procedures. Do you know if any special licensing is needed for in-office nitrous administration? Any issues with the mask staying on comfortably in prone position?

 

[soccrwz]

triazolam 0.125mg take 1 tab 45 before, then another 15 min before if still anxious. I like this better than valium as the half life is like 40 hours.

 

[BobBarker]

@gdub25 can you give more detail on the nitrous question?

I did a lumbar RFA on a lady that wiggled and cried during her mbb with some versed and fentanyl at the hospital. I did the RFA in the office today with 5mg Valium and nitrous and she didn’t move. She said it was much, much better for her.

 

[gdub25]

Setting up nitrous was no big deal. We bought a nitrous/oxygen flometer on a roll cart and hook up E cylinders to it. We bought it from a website called Atlas medical equipment or something like that. They’re easy to find on there and I want to say it cost us about $1500. We bought one to try about a year ago and it worked so well that when we built our new office in a nearby city we went back to the same website and bought another used one for that location. We just give the patient a facemask like we use in Anesthesia and have them hold it to their face while they’re getting the procedure, they can take it off if they feel like they’re getting too much. There were no regulations regarding the use of this, would have been different if we wanted to plumb everything in the walls, but as it is we are just using a roller cart and nothing has to be tested or certified There were no regulations regarding the use of this, would have been different if we wanted to plumb everything in the walls, but as it is we are just using a roller cart and nothing has to be tested or certified. you’d need to call your state department of health to see about stage regulations.

 

[lonelobo]

Setting up nitrous was no big deal. We bought a nitrous/oxygen flometer on a roll cart and hook up E cylinders to it. We bought it from a website called Atlas medical equipment or something like that. They’re easy to find on there and I want to say it cost us about $1500. We bought one to try about a year ago and it worked so well that when we built our new office in a nearby city we went back to the same website and bought another used one for that location. We just give the patient a facemask like we use in Anesthesia and have them hold it to their face while they’re getting the procedure, they can take it off if they feel like they’re getting too much. There were no regulations regarding the use of this, would have been different if we wanted to plumb everything in the walls, but as it is we are just using a roller cart and nothing has to be tested or certified There were no regulations regarding the use of this, would have been different if we wanted to plumb everything in the walls, but as it is we are just using a roller cart and nothing has to be tested or certified. you’d need to call your state department of health to see about stage regulations.

No regulations for use of Nitrous oxide?

 

[Doctodd]

Valium has a very long half life, so try to use a short acting benzo. IV is faster and more effective if you can get IV access. I used to use propofol on everyone and could do 30 procedures a day if I didn’t have to talk to anyone. Some states require a second person to supervise sedation, so the physician doing the procedure technically can’t be that person.

Nitrous is awesome. Thx for that info.

 

[BobBarker]

The lady had 50% nitrous... so with a Valium pretty deep but anesthesia docs should be comfortable. .6 MAC or so.

 

[lonelobo]

Valium has a very long half life, so try to use a short acting benzo. IV is faster and more effective if you can get IV access. I used to use propofol on everyone and could do 30 procedures a day if I didn’t have to talk to anyone. Some states require a second person to supervise sedation, so the physician doing the procedure technically can’t be that person.

Nitrous is awesome. Thx for that info.

30 a day,...more nonsense

 

[gdub25]

30 a day is not nonsense, have an open mind that maybe there are more efficient ways of doing things and get out in the real world and see for yourself. I’ve said it many times but people are welcome to come see our practice, we are very efficient.

and no, there are no regulations for nitrous oxide in our state. The only thing that was required was that if we have it plumbed into the wall then the plumbing would have to be inspected for any leaks and pressure tested.

 

[Doctodd]

30 a day,...more nonsense

sometimes 35....15 in 4 hours after lunch wasn’t hard with support staff. And it was with only 1 procedure room, but 2 PA’s seeing patients.

 

[SommeRiver]

30 on a procedure day isn't nonsense at all. What's the problem with that? I have a problem with clinics that see 40 or 50 in a day...Procedures at 30 in a day may mean one procedure day per week, maybe two per week...Who knows? There are a litany of justifiable reasons to do 30 injxns in a day.

 

[paindoc007]

30 injections a day is whatever.

I know a doctor who did 20 scs trials in one day. Now that’s bonkers

 

[gdub25]

20 trials in a day is doable, technically, but I don’t believe this unless I see some proof. Too many urban legends a out this kind of stuff and it always seems to be only somewhat true. Like some dude supposedly did 15 implants in a day, or there was a guy who did a 13 minute implant skin to skin....oh wait, that last one was actually on video haha. Guess at least some of these myths are true. I do know a doc in San Antonio who did 12 trials in a day, know him personally, it was an end of the year trying to rush for deductibles thing with a little “try to set a record” mixed in.

 

[BobBarker]

20 trials is certainly possible. 30 is probably the limit of what is possible in a 9-10 hour day.

 

[lobelsteve]

30 trials per year sounds about right. A bit more than i do, but plenty.

 

[paindoc007]

20 trials is certainly possible. 30 is probably the limit of what is possible in a 9-10 hour day.

lol...alright

 

[SommeRiver]

I work with around 20 or so orthopedic surgeons and a couple of spine surgeons...Please explain to me how one gets stim volume like that?

Someone has had back surgery and they continue to hurt so you stim them despite the fact it is strictly back pain?

I see AN ABUNDANCE of failed back, but that doesn't mean I should stim them. I guess in an avg half day of clinic I will see several pts with failed back.

Maybe I need to trial like 10 in a day, that way I can tell ppl I did it and they'll think I'm a really cool pain guy.

Truth be told, if I didn't have a seething hatred for NANS speakers and stim reps I probably would do a lot more.

Great Tx for radic and CRPS, not so great for the back.

 

[BobBarker]

I don’t think anyone said it was a good idea or that anyone has the volume to do 20 or 30 trials in a day. Just that it is possible.

 

[SommeRiver]

I don’t think anyone said it was a good idea or that anyone has the volume to do 20 or 30 trials in a day. Just that it is possible.

Someone said they know a guy that did 20, and another made a comment about 12 in a day.