Expert: Ronald Levy, M.D. - 11/14/2010

Question
Hi Dr. Levy:  I have a colonoscopy scheduled and the doctor wants to do it with sedation despite my desire to do it without drugs.  I'm not going to argue with her because she's the expert; I had my last one without drugs (another state) and I was hesitant about receiving sedation after reading so many bad experiences from colonoscopy patients.  The doctor referred me to the "anesthesiologist" (who was a nurse, o.k. with me) and I asked which drugs they used; I figured that since she was a CRNA that she would use propofol, which seems the least objectionable as I read various internet accounts. I don't want Versed (a friend still has memory problems after receiving it; I know that it's supposed to be safe, but I would rather not risk it).  What has me confused is that the CRNA said that she wants to use 3 drugs: fentanyl, versed and propofol for this simple screening colonoscopy.  I told her that I didn't want Versed (not negotiable) and didn't understand why she didn't want to use only propofol.  She only said that "that's what we give everyone and it's the best combo".  I told her that propofol and fentanyl is o.k.  since I had it before without issue.   When I reported for the test, the CRNA said that she couldn't modify the existing protocol and that I had to consent to all 3 drugs; when I documented "no versed" on the consent, the CRNA said that she wouldn't do the sedation, so I cancelled the test.  When I rescheduled without sedation, not even the GI doctor could explain why propofol alone couldn't be used.  Any ideas? Thanks,

Answer
First of all, the memory issues your friend has is unrelated to Versed. Versed causes antegrade amnesia meaning that from the time you get it until up to 6-12 hours after the procedure you may have no memory of what happened (which is often a good thing). If your firend's memory loss includes time before the procedure or after 24 hrs afterwars, it is not Versed. That being said, the combination of the 3 drugs is actually a good combination because you need less of each of the drugs because they work synergistically with each other. There is no reason why the CRNA couldn't remove the Versed if you so insisted and she was incorrect to insist on that. I would write a letter to the appropriate people regarding that. Please bear in mind that Propofol also has amnestic effects so if you are willing to accept Propofol, you should have no problem with Versed either, but you are the patient and that is your choice. Next time I would arrange with the anesthesia provider ahead of time to follow your wishes. In the CRNAs defense, all I can say is that, like a patient, she doesn't have to do anything she feels uncomfortable with. It is likely that this is all the CRNA does and she has gotten into a pattern that she knows works and doesn't feel comfortable changing her routine. That is not an excuse. She should be able to provide any type of sedation.

Good Luck,

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston