Expert: Ronald Levy, M.D. - 4/8/2008

Question
QUESTION: I had a colonoscopy and they gave me Demerol 75mg and Versed 5mg IV push (according to the dictated report). This seems like a lot to me - perhaps even unsafe. What do you think?

ANSWER: Every patient is different and these drugs are titrated to effect. I am sure they did not just take 5mg and push it. It was given in divided doses. The doses you mention do not sound excessive. For some people it is even low.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: I checked my record, and this wasn't titrated as near as I can tell - it's charted Demerol 25mg and Versed 2mg every 2 minutes (1 mg of Versed the last dose) before they even started the procedure. That indicates to me that it wasn't titrated to discomfort - perhaps to the level of (un)consciousness they wanted, but certainly not to discomfort because they didn't do anything until the whole dose was on board. The reason I'm asking about this is that I told them I didn't want to be snowed for the procedure and apparently it went in one ear and out the other. As it wasn't really titrated, what effect would you be expecting with this total dose being given all within less than 5 minutes?

Answer
We usually try to get to a certain level of sedation before we start the procedure. If we did it the other way, you would have discomfort and then we would titrate. After the initial dose, if we then see that you still are uncomfortable, we add more, but more than likely, at that point, you wouldn't remember any way. As for the speed, it was probably a little fast, but not significantly. As for not being snowed, I can't speak for why they did that but the problem with Versed is that you either get it or not. If you didn't want to be snowed, they could have done the procedure with nothing but you would not have liked that. By giving you Versed (even a small dose), the amnestic qualities will still work.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston