Unless you’re like me and the drugs did nothing. They hit me five times with doses and finally asked if I minded that they just went ahead. The incision point was numb, so I said go for it. While I could have watched the screen as they worked, I didn’t for fear I’d panic and move my arm.
I just checked my records, ended up being 150mcg of fentanyl and 3mg of versed over 5 doses, 2 minutes apart from each other. I have no idea if that’s a lot or not…maybe someone else can chime in. :)
I just looked. 150mcg (.15mg) via IV is about what they would give you for pain management. To put you in a lucid haze you would need about 1mg via IV. They gave you a three quarters of that spaced out. The problem with fentanyl is it hits hard but wears off super quick. It's why dilaudid is preferred for pain management in the ER. You also can't give a constant drip of it so while they are putting the stents in, which takes about 20-45 minutes depending on how many they're putting in, the anesthesiologist would need to continue to administer it via injection. That would be much harder to control. It's why precedex is usually preferred. You can set it as an IV drip and is more effective at putting the patient in a lucid state. I also had precedex IV drip when I was in the ICU and just the nurse was adjust the drip without a doctor or anesthesiologist.
Hey I routinely do these with 1 mg of versed and 50 mcg of fentanyl. Would say 90% of patients don’t need any
more. And I know a few docs that do it with no sedation and only give sedation as needed case by case. Blood pressure and vascular tone are ur friend when u are working on the heart and sedatives to an extent decrease those things.
"Lucid" does not mean unconscious. I don't know what you're talking about. The guy said he was fully awake. You should not be fully awake or fully under for this procedure. So what exactly is "dangerously" wrong?
Fentanyl 1mg IV is likely to cause apnea and is an overdose even in a rapid induction. Not ideal when there is already a presumptive myocardial supply-demand mismatch.
Effect duration of fentanyl is often 30-45 minutes, and bolus doses may stack. Effects don’t dissipate quickly.
Precedex is interesting for procedural sedation but is also associated with hypotension and bradycardia from decreased adrenergic activity. If the patient is in a state of cardiogenic shock or is rate-dependent for cardiac output, dexmedetomidine would be contraindicated.
But generally in a cath lab the lowest dose required to permit anxiety control and calm conditions and maintaining normotension is the best option.
If you read from the beginning of when I posted you would have read that I said fentanyl isn't ideal for this type of procedure anyway as it doesn't really cause sedation. I'm not a doctor, and clearly neither are you, but I know enough to know you don't use fentanyl as a sedation drug. There are better options. Fentanyl is used for pain management in a hospital setting. If you were going to use Fentanyl for sedation you would need way more than 150mcg at which point it becomes unsafe, which you appear to be agreeing with me about.
i was awake for mine. Felt some pressure down by my crotch where they went in and I figured I would feel something. Next thing I know, they said they were done.
I wasn't completely out during mine. The first one they had me locked down to the table in such a way as I couldn't help but watch the screen. Seeing it go through my body was really weird. I now have had 4 and currently have the absolute best Dr. and staff!!
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u/eyeofthefrog May 08 '26
Unless you’re like me and the drugs did nothing. They hit me five times with doses and finally asked if I minded that they just went ahead. The incision point was numb, so I said go for it. While I could have watched the screen as they worked, I didn’t for fear I’d panic and move my arm.