Transitioning from using Deep sedation to moderate sedation - learning curve?

[spartymedicine]

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Hi,

On the job hunt right now. I have found some nice jobs but they use moderate sedation (Fentanyl/Midazolam) for endoscopy. I have done basically all my training with deep sedation (Propofol).

Is the learning curve for doing this steep? I guess I am wondering when you run into a tough colon that is redundant you need to push through a loop..
Or when you're doing an EGD and someone starts desatting a little..

Should this be a dealbreaker or is it relatively easy to get accustomed/transition to?

 

[Radetzky]

Moderate vs deep sedation is not based on the type of drug you give. Even with deep sedation a patient will respond/move to a painful stimulus like pushing through a loop of bowel- if they aren’t then what you’re actually giving is GA without an airway. Also your patient is more likely to desaturate with deep sedation.

Who is giving the propofol at your current place?

 

[spartymedicine]

Moderate vs deep sedation is not based on the type of drug you give. Even with deep sedation a patient will respond/move to a painful stimulus like pushing through a loop of bowel- if they aren’t then what you’re actually giving is GA without an airway. Also your patient is more likely to desaturate with deep sedation.

Who is giving the propofol at your current place?

CRNA does. So do you think the procedures take longer with moderate vs deep? Like if my cecal time is around 4-5 min with propofol, how would it be with moderate?

 

[Suprep]

CRNA does. So do you think the procedures take longer with moderate vs deep? Like if my cecal time is around 4-5 min with propofol, how would it be with moderate?

If you haven't been trained in moderate sedation, not worth it. you need to give sequential sedation dose, patient moving, uncomfortable.

 

[chessknt]

You have to be trained in airway rescue if you want to give moderate sedation. How many of those have you done? Do you feel comfortable resuscitating someone if you overshoot?

Agree with above, if you think the drug determines sedation level you have 0 training in it thus far.

 

[1Cor1557]

moderate sedation will take longer, but if you go low and slow you shouldn't be afraid to learn and get comfortable with it, if anything, with a big chunk of the population obese smokers and on THC/opioids/psychotic meds your just standing around staring at the patient wide awake after 15 minutes while trying to titrate your moderate sedation , but then your employer is shocked you havent done more cases, when they can't recruit or won't pay for anesthesia, probably the most annoying part of it