Expert: Dr Ian Jackson - please note UK based - 8/20/2008

Question
When sedating a patient with Fentanyl and Versed; is there a reason to give Fentanyl first over Versed? Or vise versa?
I have not found an answer to this as of yet.
Thanks for your help.

Answer
Hi Joan

Mmmm - in the UK we would not define the use of an analgesic AND a hypnotic as sedation. This is sedoanalgesia and most UK anaesthetists believe that its use should be firmly regulated. Indeed we had so many problems in sedation for dental work in the UK that the use of this type of combination was banned. However it is still extensively used in endoscopy units in the UK by gastroenterology colleagues.

From a pharmacological point of view I would give the analgesic first - fentanyl takes 5-10 minutes to achieve its maximal effect. Once it has had a chance to reach the receptors you can then titrate sufficient midazolam to achieve the required level of sedation in alliquots of no more than 0.5mg at a time. Giving the midazolam first raises quite a risk of over sedation and even respiratory depression when the fentanyl finally gets to the receptors.

I hope this arguement makes sense to you and is of use.
Kind regards
Dr Ian Jackson