Expert: Ronald Levy, M.D. - 4/8/2009

Question
I am a 46 y/o man, 6'03 and 230#.  A couple of weeks ago, I went to the hospital as an outpatient for electrophysiology testing and catheter RF ablation of SVT.  During the EP testing, I was first given 2 mg midazolam and 10 mcg of fentanyl.  The sedation nurse told me this would be a "little taste" of the sedation and that she could not put me to sleep during the EP testing because the sedative meds would make it more difficult to elicit the arrhythmia.  I was beginning to think the sedative would have no effect on me when, about 2 minutes later, my vision started to blur and I felt the medicine kick in.  The electrophysiologist spoke to me as he was preparing to insert one of the catheters in my jugular vein and had the nurse give me an additional 2 mg of midazolam.  I don't really remember alot of the next 30-45 minutes - the next thing I recall was feeling my heart pounding and racing as they paced it, infused Isuprel and were working to stimulate the arrhythmia.  Once they ended the testing and prepared to perform the ablation, the nurse gave me an additional 4 mg of midazolam and 50 mcg of fentanyl.  Next thing I knew, an hour had passed, the catheters had been removed and they were preparing to move me to a cart to take me back to the recovery area.  I am a very satisfied customer, but curious:  Was I likely asleep/unconscious with those doses of midazolam/fentanyl or just amnesic with no memory of the procedure?

Answer
The doses you got were not excessively large but each person reacts differently. Midazolam is supposed to make you amnestic so I guess it did the job. As to whether you were asleep, I can't say but more than likely you were. You were probably not unconcious.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston