Expert: Ronald Levy, M.D. - 4/29/2011

Question
Dr. Levy,

I find it disturbing that in the US, sedation with Versed or diprivan is offered for all sorts of minor procedures often in the absence of a qualified anesthesiologist.

In France and most of Europe, Versed (aka Dormicum, midazolam) is strictly approved for use only in an ER setting by emergency doctors and anesthesiologists. There is a warning in the Vidal reference (the French PDR) that midazolam should be administered with opioids extremely carefully due to risk of respiratory suppression. In the US midazolam (sometimes with opioids) is widely used for endoscopies and dental procedures as well.

Are gastroenterologists and oral surgeons prepared to handle the complications of sedation?

Midazolam alone does not relieve pain but supposedly produces amnesia in some cases and vague traumatic memories of the procedure in others. So why is it so commonly administered in the US?

It also seems to me that offering and even pushing sedation onto
patients is extremely common in the US. Is that a cultural thing or is it evidence-based? Are US physicians afraid of uncooperative patients or frivolous lawsuits?

Thank you for your input on this issue,
Alex

(I would also like the input of your UK colleague, Dr. Jackson, but he is currently on vacation)

Answer
Both providers are supposed to have taken courses in sedation anesthesia. I know that most oral surgeons take 1 to 2 years of anesthesia training. As for why we use it so much, it's becauseit works so well. I have not heard any reports of traumatic memories. We don't push it on patients but why should we let patients suffer if we can avoid it. Some people think amnesia is a bad thing but having had Versed myself, I think it is a wonderful thing. If a patient refuses Versed after hearing the benefits, I don't force them. They have final say. It has nothing to do with litiginous or uncooperative patients.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston