Expert: JM Starkman, MD - 9/1/2010

Question
I am scheduled to have a minor outpatient gynecological procedure (approx 20 minutes) and the doctor has mandated that I be under IV sedation for this.  They generally use Versed and Propofol.  I have had sensitivity to prescription medications before and prefer not to take any kind of pain medications, which given my high pain tolerance has not been a problem in the past.  I am absolutely terrified, not of the procedure, but of having to be sedated.  I would feel much more comfortable if I was awake and aware of what is going on during the procedure.  I realize that my anxiety is a psychological issue, but are there any alternatives out there for short procedures that would allow me to be coherent and that would leave my system quickly afterwards?  

Answer
[Pls excuse my delay in replying as I've been on vacation]

Yes, there are alternatives.  If your "mandating" doctor is so uncertain about his abilities to utilize local anesthetics to keep you pain-free or nearly pain-free during this minor procedure....and he or she does not recognize you as a "slow-acetylator" (google it) which you  likely are given your history, then my first alternative is second opinion/new surgeon.

Alternative #2 would be sedation with propofol ONLY with an anesthesiologist administering it after he's had a chance to obtain a proper history from you well prior to your surgery date.

If this is truly a minor procedure,  using local anesthetics only should not present a problem---you didn't mention the specifics of the procedure (?beast biopsy ?cerclage ?cone biopsy)---but if you're getting into a tubal ligation, bladder suspension, etc. that may not work well with some degree of anesthetic muscle relaxation that would require additional anesthetic type meds that your surgeon feels would be necessary.