Tuesday, March 9, 2010

Conscious Sedation Update

Brooke just got home from work a few hours ago and read the last blog entry. She would like me to provide some more information, mainly for her nurse friends, about the conscious sedation procedure I underwent to remove my boot from my mashed potato ankle.

As she explains it, it took, "an obscene amount of drugs to sedate Tony. This included 100 mcg of Fentanyl, 5 mg of Versed, and ETOMIDATE!" She asked that I add the emphasis to the last drug, pictured above in 3D!

Let's admit it. Most of us have no clue why this amount of drugs is obscene. Therefore, to all of our nurse and doctor friends, and to Brooke's co-workers, it is now your duty to explain what this means to the rest of us.

I especially would like to know if I was just a few mg's, or whatever mcg's are, away from being consciously sedated for infinity.



  1. One of my buddy's brother is a pathologist. He said this all sounded normal, Brooke! Looks like the husband isn't the only one known for exaggeration! OHH!

  2. First time blog comment here:
    Your medication regimen for conscious sedation was appropriate. Maybe Brooke isn't familiar with etomidate. It can only be administered by an anesthesia provider, so it shouldn't show up on her radar very often.

    Can you retell the story of when you gave blood in Tulsa? The one where the phlebotomist had to stick you 4 times and there was blood everywhere. Didn't you pass out?

    I really enjoyed your blog, especially the part about how you cried like a man the entire time.

    Hope the second part of your recovery goes well.

  3. As one of Brooke's "nurse friends", gotta stand up for Brooke and add my 2 cents...Holy crap! Especially the part about breaking out the ETOMIDATE on top of 5 of versed?! Etomidate is a fun little drug we usually like to push right before we take away your ability to breath for yourself and put a tube down your trachea.

    Tony, I've never met you but I do admire your tolerance! Hope your recovery goes well.

    Best wishes,

  4. Thanks for the support, Cecilia!

    I just looked through the Breckenridge Clinic insurance claim form and didn't see anything about the Etomidate. I was hoping to get the amount they gave me from their claim. A lot of their entries are described as, "Emergency Room - General."

    It was enough, though! Very glad they knocked me out.

  5. We use etomidate. However, it is not standard protocol for us to break it out so quickly for use during conscious sedation (even though it may be used that way). Actually, we rarely use it in conscious sedation, which is why I was thinking to myself-holy moly, Tony's quite tolerant. I don't recall the dose they used.

    Since then, we have truly seen his tolerance. After the second surgery they had to give him multiple 4mg Dilaudid IV doses on top of receiving Oxycontin and Percocet and Valium.

  6. I dominate high-dosages. I've been saying that for years.

  7. Dude, it sounds like they tried to go all Conrad Murray on your ass.

    In Brooke's defense, it is a good amount of sedation. I've been acting like an ED doc for the past month, and we often will give etomidate for sedation and some fentanyl for analgesia when reducing fractures. The fact you required a decent dose of versed means you probably were still a little awake, or perhaps they just wanted to sustain your sedation with some longer acting versed. Alternatively they may have tried some versed and just gotten nowhere, then hit you with the etomidate. Certainly etomidate/succ is a common combo for rapid sequence intubation as noted above, but etomidate doesn't usually suppress respiration--its actually a great drug, most commonly used by ED docs as it causes almost no decrease in your blood pressure (as most sedatives do) and so its great in often unstable ED pts.

    Certainly, Jillian, etomidate can be given by any provider, and is used all the time by ED docs, so I'm sure an ex-ED nurse such as Brooke has seen it pretty often. Even lowly Internal Medicine residents can write for it every now and then.

    I'm reading the blog for the first time--I've really enjoyed following your bowel movements via gchat status updates.

  8. Now that I think about it, Versed may actually be shorter acting than the etomidate...so one of my hypotheticals up there is probably a load of crap.

    So probably you just have a ridiculous tolerance.

    Bravo. You drink too much.

  9. Not really impressed. I recognize 100% of those drug names from the show ER.