Expert: Ronald Levy, M.D. - 3/26/2009

Question
QUESTION: Someone posed a question regarding the use of Versed. Yo said the purpose of Versed is to relax you and to give you amnesia for the procedure. You had made a comment in a response that said the amnesia can last up to 24 hours.  What do you mean?  Will I remember the procedure after that time or will I be having prolonged amnesia for things I do for 24 hours after having had the versed.  I had a colonoscopy and am very upset that I wasn't told of this purpose of the drug being administered.  I feel angry and violated in that I did not make an informed consent to use of the med.  It gets my blood pressure up just thinking about this.  Please give me the details of the effects of this drug after administration is stopped - and for how long.  thank you.

ANSWER: What I meant is that the effects of Versed can last for 8-24 hours (which is why they tell you not to make any important decisions on the day of the procedure). Everybody is different. Some people have no amnesia and some can last a day. You will be amnestic for the procedure but after that, you won't be amnestic for the rest of the day. What MAY happen during the day is like the example below:

A friend of mine had a colonscopy and called me an hour after the procedure to tell me about it and he asked me some questions. I answered his questions but told him he probably won't remember my answers by the afternoon. He called me in the evening and told me he had a colonscopy and asked me some questions (the same questions). When I told him I had answered those questions before, he couldn't believe me until I told him things about the procedure that I couldn't have known otherwise. He remembered everything else that happened that day.

As for your anger, it is probably not warranted. Normally when I speak to a patient preoperatively I tell them that the medicines I give them will likely give them amnesia and they won't remember the procedure, but there is no separate consent for the meds. Your consent for anesthesia basically entrusts the anesthesiologist to give you those drugs that he/she feels are safest and will make your experience as plesant as possible.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

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

QUESTION: I guess I am most upset because I had expressed my concern of being put under and especially possibly feeling lightheaded - which I do not like.  It was never explained to me that the purpose was to induce amnesia - I told the anesthesiologist that I have a high tolerance for pain - 2 children - one induced by Pitocin and had coupling on top of the 10 hours of transitional labor - I also have had at least 5 needle biopsies in my neck for a thyroid nodule without topical anesthetic, dental work w/o lidocaiine, etc.  I do not drink or smoke, don't take drugs (ever) unless absolutely necessary (rare) - and therefore I am easily affected by anything such as alcolhol or certainly something like Versed.  At the time of the colonoscopy I was 30 hours without sleep - so of course I literally fell asleep after being givent the med.  So for the anesthesiologist to say I was asked if I wanted him to administer more meds because I appeared to be in discomfort (they say I grabbed my stomach and grimaced - OF COURSE someone would grab their stomach with a tube being passed inside - it does NOT mean I was in pain - my face may have just been a reaction to discomfort but not something that I couldn't tolerate)  I am really upset that I don't remember anything and how on earth could he expect a cognitive answer when I obviously could not have been thinking or assessing anything with a clear head.  I feel tricked and yes, angry, disappointed,etc.  He even said to me that there are people, like himself, who have the procedure without anything and after it was over told me I absolutely could have the procedure done with nothing.  If that's the case, why give me more med during the procedure?  I don't have a good feeling about what happened and I HATE that I CAN'T remember...

Answer
There are several answers to your question. Yes, it can be done without any meds (as was done on my wife when she was pregnant and could get meds) but it is very uncomfortable and may make it hard for the GI doc if the patient is squirming too much, etc. It is also not a pleasant thing to remember for most people. As for being asked about more meds, while you are not cognitive enough to consent for surgery, etc, you are still awake enough to know if you are in pain or discomfort and can answer that question (if you don't answer, then you are sleepy enough and they won't give you more).The anesthesiologist should have told you about the amnesia but now you know for the future. I get a lot of questions and complaints about Versed on this site and I understand the feeling that people have about not remembering but I would say the majority of the people I speak with after the procedure (when I ask them if they remember anything) thank me for making the whole process so pleasant. If you are dead set against having amnesia, just tell future anesthesiologists your wishes and they should comply with them.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston