Expert: Ronald Levy, M.D. - 6/17/2009

Question
Dr. Levy, in your response to a recent question entitled "Colon scope without versed" (asked on 6/15/2009), you indicated that you agree with the asker's GI doctor's statement that "most [...] Versed horror stories are untrue." You then went on to say that "[t]he majority of Versed complaints have to do with the amnestic effect of the drug. A lot of patients don't like the feeling of not remembering what happened. The fact is, this is an expected (AND desirable) effect of the drug." Having read this response of yours, I have two related questions for you. First, on what basis did you form your opinion that most Versed "horror stories" are untrue? I think if anything smacks of "untrue," it is the peculiar and seemingly reflexive (and, by the way, weak) defense, routinely issued by medical practitioners like yourself, of a drug that many people clearly abhor and that has caused intense, ongoing suffering in many patients. My second question is, exactly how can you characterize as "fact," the idea that amnesia is a "desirable" effect of Versed? You said yourself (see above quote) that "many patients don't like the feeling of not remembering what happened." Well, if that is indeed how "many" patients feel, then how could you possibly characterize the very thing they "don't like" as being "desirable" in any way? Could you instead mean, for example, that the inducement of amnesia in patients is "desirable" to YOU as the anesthesiologist? Alternately stated, to whom is amnesia desirable? Your very own words indicated that many patients don't like it. How, then, is it desirable? Please clarify.

Answer
Let me start with the second question first. When Versed was developed, it was designed to relieve anxiety, be shorter acting than Valium and to cause amnesia. To use an analogy, one of the desired effects of roller coasters is to give an adrenalin rush to the rider. Because many people don't like that feeling, does that mean that we shouldn't make roller coasters?? Or to reverse what you're saying, Just because some people don't like the amnestic effects of Versed, should we withdraw the drug from those patients (the majority) who do want that effect? The fact of the matter is that Versed is given 10s of thousands of times every day and perhaps less than 1% of patients don't like the effects. As an anesthesiologist, it is not desirable to ME for the patient to be amnestic other than as benefits the patient. Our role is to make the procedure as pleasant for the patient as possible, and for most people who have a fear of pain, fear of surgery and fear of bad outcome, not remembering their time in the OR is desirable. As to the first question, it follows from my first answer. The only "horror" stories I've heard are related to amnesia which, as I said, occurs in less than 1%. You quote that many people have "intense, ongoing suffering"...what is the evidence for this statement. What exactly is the "ongoing" suffering?? People may not like the feeling of lost memory, but I don't know of any reports in the literature discussing long term psychological effects from Versed administration.

So in summary, if you are one of those people that wants to remember all the fine details of your procedure, tell your anesthesiologist not to use an amnestic (and they won't), but don't deny to people who don't want to remember, the right to have Versed.

Hope this clarifies the situation,

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston