Expert: Ronald Levy, M.D. - 4/22/2009

Question
I need to have a chemo port put in -- I'm allergic to conscious sedation -- profound amnesia effects for months afterward and to substances such as demorol, valium, darvon, etc., etc.  They do nothing for pain but do cause loss of consciousness, difficulty breathing, dizziness, and in some cases hallucinations.  The radiologist offered fentynol and versed -- both respiratory depressants and if you can't take valium, you can't take versed.  What sedations are effective for putting in a chemo port and will effectively block the pain and not cause memory deficits and anmesia after the procedure?

Answer
There is no such thing as "allergic to conscious sedation". When you say you have profound amnesia for months, are you talking about antegrade amnesia (you continue to forget new information for months after surgery)? This is not an allergy but should certainly be evaluated. As far as the drugs you mention, demerol and Darvon are long acting pain killers while Valium is a long acting anxiolytic (particularly in elderly people). Versed is a short acting anxiolytic and amnestic agent while Fentanyl is a short acting strong narcotic. These are the usual drugs we use for conscious sedation. I can promise you that the Fentanyl will treat your pain. As for amnesia, Versed will cause it but it shouldn't last for more than 12-24 hours. The drug they will use to block pain during insertion is actually the local anesthetic.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston