Second OpinionsMonitoring patients after midazolam

Monitoring patients after midazolam

Our patients often receive midazolam as they are leaving pre-op to go to the OR, and are accompanied by anethesia. If the patient remains in pre-op after midazolam is administered, do you always put the patient on a pulse oximeter, regardless of how many minutes ago they were medicated?

Started by: Maureen Darling (Other) at January 31, 2013 (12:26 pm)

Comments and Responses


If my patient has not required any medication prior to rolling to the operating room what benefit are they really going to receive from a dose of midazolam while rolling down the hall. I ask my patient if they need something for pain or to calm their nerves as part of my routine preoperative assessment. If I medicate them they get monitored with a pulse oximeter and my continued presence. I do not wait for the surgeon nor the anesthesia attending to see the patient before treating their pain/anxiety. I do check with the preoperative RN to be certain there are no issues that would preclude medicating the patient. I do inform the patient receiving midazolam that it may impair their ability to remember things. It seems today that many anesthesia providers believe EVERY patient MUST receive 2mg Midazolam prior to surgery. Why? If the patient is getting their anxiolytic while rolling to the room, how much benefit is it? As far as the time out issue, again I am afraid I do not see an issue. Our presurgical time out is done just prior to incision, and the patient does not participate.

Robert Dickinson (Anesthesiologist/Nurse Anesthetist) at March 17, 2016 (9:22 pm)

I agree with the person that referenced the time out as being invalidated just as a consent would be if the patient were pre-medicated for the OR. Medicating patients with versed requires monitoring for patient safety. This is not negotiable.

Michaeline Simek (Director, Surgical Services / Director of Nursing) at April 11, 2013 (7:36 pm)

Monitor. I am curious about thoughts on pre-op midazolam and "time-out". It would seem to me that pre-op midazolam would render "time-out" with patient participation useless.

D. Solomon (Medical Director/Chief Surgeon) at February 26, 2013 (8:15 am)

OMG! Does anyone else besides me remember when a pulse ox was NOT required equipment in the post op area much less the preop? What ever happened to "Treat the patient, not the pattern."?

Tracy R. (Director, Surgical Services/Director of Nursing) at February 15, 2013 (10:20 am)

Without trying to turn this into an unnecessary battle of words, I believe the person asking the question was NOT assuming that the Anesthesiologist was giving pre-op midazolam and immediately transporting the patient to the OR. I assumed they meant a standing order for midazolam for anxiety and then waiting for the procedure. However, re-reading what you wrote, I saw "it is not necessary to monitor via pulse oximeter preop versed" and "Regardless of that a MINIMAL dose of versed will not cause significant depression." Your time frame of giving if after all have seen the patient, then heading into the OR is how it should be done, with the Anesthesiologist at the head of the bed. For those who were like me and thinking otherwise, READ THE PACKAGE INSERT. Monitor your patients if you are going to give any sedative/hypnotic/anxiolytic and not immediately take them into the OR. It isn't a CYA issue but one of meeting a standard of care and again assessing the risk/benefit ratio. I think we are in agreement but I wanted those who are NOT Anesthesiologists or don't HAVE an Anesthesiologist directly involved in the care of their patients (i.e., GI patients at ASC's in California) that you monitor every time.

T. Durick (Medical Director/Chief Surgeon) at February 8, 2013 (10:05 pm)

Perhaps you should read what I wrote again. I reiterate preop sedation as I describe is sedation given prior to the patient going back to the OR ESPECIALLY versed. Because of its potent amnestic properties I DONT GIVE IT UNTIL WE are ready to go to the OR, thus I am always with the patient. By many of y'alls logic you should thus recommend that when we transport patients to the OR they are monitored. Extend that further to children. Do any of you seriously monitor the kids after an ANXIOLYTIC dose of versed is given to the child prior to surgery? The discussion here is one that plagues our medical culture- CYA. Instead of using logic. Remember I speak as an Anesthesiologist, not a proceduralist, ED doc or radiologist who may order versed "way ahead" of time. If I have a patient who arrives early or is delayed in preop and is very anxious I may order some po lorazepam or whatever med they may be on. Do I put a pulse oximeter on? Bottom line is people, you can put on a pulse oximeter, BP cuff, ECG and all matters not if you don't watch it. I NEVER give versed and walk away, exccept for po versed to children and we still check on them. Nothing beats your eyes and brain- not even a pulse oximeter.

P. Rein (Anesthesiologist/Nurse Anesthetist) at February 4, 2013 (11:04 am)

As an OR nurse for over 40 years, I have seen patients even with a minimal amount of versed have respiratory depression. For the safety of the patient you must monitor all of their vital signs. You never know how a patient will react when given seadtion meds.

Rebecca Williams (Administrator/Director/Manager/Owner/Exec. Officer) at February 4, 2013 (10:50 am)

This should not even be discussed. Lack of monitoring, is simply lack of safe care that we commit to provide to any patient.

Sarah McKeever (Director, Surgical Services/Director of Nursing) at February 4, 2013 (9:48 am)

Any patient can respiratory arrest from IV sedation. You can not be sure of how a patient will react even with a good history and exam--you don't know what other medications/drugs are in their system as well as what affects this sedative will have on this patient. You must monitor all patients receiving any IV sedation with a pulse ox minimally---EKG and pulse ox monitoring is done for all patients receiving any sedation in Holding at my facility

Marie Bromm (Other) at February 4, 2013 (9:17 am)

D. Rein needs to practice just a little bit longer! i've seen significant respiratory depression occur with 1ml iv on a healthy 59 year old male! Scared the crap out of me because there were no other meds involved. i too had been doing this for close to 30 years and had never bothered with pO2 monitoring since this dose usually never did anything but make the patient less nervous. Fortunately this one happened immediately in front of me but i shudder to think what would have happened had i walked away!

Marguerite B. (Medical Director/Chief Surgeon) at February 2, 2013 (9:23 am)

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