Expert: Ronald Levy, M.D. - 8/31/2008

Question
QUESTION: I had a endoscopy and apparently became violent midway through the
procedure because I was coming out.  The procedure had to be stopped
quickly.
My perception of all this this was complete terror of what was happening but
no real memory of what was going on.  I did not become responsive for over
2 hrs after the procedure and upon being taken home. I fell over in mid
sentence while in a sitting position and did not become aware until 5 hrs
later. I awoke with these some terrifying feelings of being assualted.  For 3
days now my sleep has been interrupted with the same terrifying nightmare.
I tried to consult with the doctor to get some understanding of this but only
get a defensive stance that everything was appropriate.  I'm not questioning
proffessional competency  but need understanding of why this is happening.
Can you help shed any light on what I been told that's only a problem
exclusively individual to me?



indiividual to me?

ANSWER: Not knowing what you received makes it hard to say what happened but usually for endoscopy, the procedure is done under sedation. That being the case, you received either Versed or Valium and probably Fentanyl (a narcotic). The Versed is an anxiolytic and an amnestic (which is why you remember little). It can also cause disinhibition which probably explains why you acted out. As for the falling over, etc, I can't explain that. The loss fo sleep and feeling of assault is probably because you don't remember what happened and therefore are concerned by that. I am sorry for your bad experience but probably everything was done correctly. Should you need this procedure again, you should tell them what happened this time so they might make the next experience better.

Ronald Levy, MD
Associate Professor of Anesthesiology
UTMB-Galveston

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

QUESTION: I did find out that the sedation medicine was Promethazine for the
endoscopic procedure. Are there any indications that this drug would cause
hyperactivity when under sedation, nightmares and prolonged sedated state
after the procedure?  In response to my not remembering, I do remember the
voices of the medical personal in the room and the gloves hands upon my
face and I wanted to shout out that what they were trying to do I was feeling
terrified of, but was not able to do.

Answer
Promethazine (Phernergan) is usually given for nausea and vomitting although it can be used as a sedative. It is a strange choice as there are much better agents on the market. You can get hallucinations and agitation as side effects of this medicine although it is not that common. If they were doing an upper endoscopy then you would feel the hands near your mouth as they were holding the endoscope. If they were working from below, then you might feel the hands as they were trying to maintain an open airway. I'm sorry for the unpleasant experience you had.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston