Expert: Ronald Levy, M.D. - 2/7/2008

Question
I am about to have a revision rhinoplasty with a specialist who is very well-known and has literally done over 6,000 noses. He always uses IV Demerol (starts with an injection in the hip) and local injections in the nose. He says it's "kind of old school" but that it works for him. I asked if there was any Versed in the IV (in other words, I want it!) and he said "there can be." So I was going to request it. But my local ENT (who knows him, although I don't think that had any bearing on his comment) said I should go with what the doctor usually does, and skip the Versed. He said, "Don't rock the boat." I must admit that is a valid argument as well. But I know I am always completely unaware with Versed and have never had any problems with it. And, I'm an anxious patient. What do you think, should I request the Versed or just trust the doctor and let him do what he usually does?

Answer
You have a dillema. If the surgeon does not use Versed on a regular basis he may not be attuned to the possible problems with mixing narcotics with anxiolytics (respiratory depression, etc). On the other hand you want to be relaxed and amnestic. Any chance the surgeon can work with an anesthesiologist on your case? If not, find out how often he uses the combination and if that makes you feel reassured, use the mix, otherwise you have to decide what is more important...your anxiety state with him or with another qualified surgeon who uses both drugs.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston