Expert: Dr Ian Jackson - please note UK based - 3/20/2009

Question
I have to have an open excisional breast biopsy, and was told I will get local anesthesia plus IV sedation.

I am very scared of the IV sedation part.  I am worried about feeling like I'm going to be too deeply anesthetized.  I've read about Versed and know that the amnesia aspect of it would terrify me.

What are my IV sedation options?  I am very anxious about the procedure, so I'd like something that will take away the anxiety, but I don't want any amnesia about it if possible.  Also I don't want anything that will make me feel like I can't breathe or that my intercostal muscles are paralyzed, because I start to panic when I feel that happening.  

Answer
Hi Emma
This is a question that you need to pose to your surgeon and anaesthetist. There are options available to us anaesthetically that can provide a degree of sedation without amnesia. However the amnesia aspects of midazolam are often overplayed. In small doses typical of that needed to help you through a procedure there is little evidence of amnesia in most patients. If you are sedated to the point of sleeping through the procedure then yes you won't remember much about it.
I am not going to go through alternatives as it may well be that in the UK practice is different to the States. I may well mention possibilities that are not available. That is why it is important that you voice your concerns to those who are looking after you so they can help you deal with your fears.
Kind regards
Dr Ian Jackson