Expert: Ronald Levy, M.D. - 6/15/2011

Question
QUESTION: About a year ago I had a very bad reaction to versed during a cardiac ablation at a med school in Utah. Psychiatrist said I had ptsd. Mostly gone now but still feel the aftereffects sometimes. I wonder if reactions like mine are more common than most people know. My doctor has not even talked to me about this even though he can see how visibly shaken I am when I go back to that hospital. Also I wonder if the fact that the crna missed the indications of a bad reaction, anger and annoyance, and continued giving me versed through the whole procedure contributed to the severity of my reaction. I don't understand how this drug that almost destroyed my life is used so heavily. Another thing I don't get is that if I had an allergic reaction to a medication that caused me a physical problem I would have been treated appropriately. But since my reaction is psychological the doctor and staff just blow me off like it is "normal" reaction. Let me be clear I almost lost my job and house because of this "rare" reaction.

ANSWER: First we need to differentiate between an allergic reaction and a bad reaction. An allergic reaction (by definition) is an abnormal immunological response to a drug or antigen. It causes rashes, swelling, respiratory distress, etc. Having a bad reaction (which it seems you did) is completely different. Not having seen the reaction, it is hard to characterize what happened. Versed can cause disinhibition which is probably part of what happened to you. I can't comment on the CRNAs lack of vigilance in realizing this and changing her plan but it is not fair to blame it on the Versed. Your reaction (to that extreme) is very rare. Normally Versed has a wonderful effect on people. Having had it several times myself for procedures I can tell you that it made me relaxed and amnestic to the procedures where I was told that I was moaning and moving during the procedure due to the pain of the procedure but I blissfully remember none of it and for my part I had a nice restful sleep. Assuming that Versed was the only drug you got and therefore clearly the culprit, it is clear that it should not be given to you again. There are many other ways to give you sedation if it becomes necessary in the future, but please don't discourage your friends and family from Versed (which has been used successfully for >20 years) because you had a bad response. It would be like telling people not to drink milk because you are lactose intolerant.

I hope this helps you understand a little better,

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: I too have had this drug several times previously with no problems so I am confused as to why this last time was so different. I have read that when the patient is very anxious before this drug is given, it can increase the chances of a bad reaction. Any truth to that? In my own case the nurses taking care off me, for some reason thought it was necessary to put me in restraints for the foley insertion, before sedation was given. Kind of freaked me out. Appreciate your opinion.

Answer
Actually the opposite. If you've had this drug before then it is likely that they just didn't dose it correctly so they got you into a disinhibited state and perhaps a little more and you would have been properly sedated. Why they put the foley in before sedation (knowing they were planning on sedating you) completely confuses me.


Ronald Levy, MD
Professor of Anesthesia
UTMB-Galveston