Expert: Ronald Levy, M.D. - 7/20/2011

Question
Hi Dr. Levy and thanks for reading my question. I had a serious adverse drug reaction to Versed and want to know how I can avoid receiving it in the future.  I have read all of your comments and I was impressed that you shared your own positive experience with Versed..my own experience was a nightmare; I had 4mg of Versed (only agent) for a simple surgical procedure; even before any additional drugs could be given I had a paradoxical reaction: shaking, extreme "dread", difficulty breathing etc and I begged the nurse not to give me any more of this drug.  Rather than having a calming effect, I freaked out and acted like a complete idiot.....sounds like a joke to people who think that Versed was "great".. It wasn't a joke to the nurse who was giving the drug; they tell me that we had quite a struggle (she was hurt)....I was mortified to hear about this; it was bad enough to have the procedure aborted, but when I heard that the ensuing paradoxical reaction actually injured the nurse, I'm quite ashamed even though I don't remember the incident too clearly. Anyway, please accept that Versed is a bad drug for me!.  High-risk for colonoscopy be damned; I'll never be given a drug that causes me to act that way (and not remember again). Fast forward to surgery: I tell the anesthesia folks the story  and they promise not to give me any.   Unfortunately, I was given a dose of Versed despite their promise just before surgery and I had a severe reaction again.  At this point, I reschedule surgery only because the pain is really bad.........I ask what I can do the make sure that I don't get Versed and I hit a brick wall: "almost everyone having surgery gets Versed, just relax and trust us to take care of you (CRNA)......I write on the consent: "I'm not consenting to Versed or other benzo or amnestic drugs" and ask the CRNA and the anesthesiologist to sign the consent; afterall, they verbally agreed to this, let's document it.  The anesthesiologist co-signs the modified consent immediately and apologizes for my previous treatment.......no worries, things happen, I say.  The CRNA tells me that She is the one running the case as far as my anesthesia is concerned and refuses to sign..I ask why and she says that: "you have to take my word that I won't give you Versed"....I tell her that's waht I was told last time and I got Versed anyway..........She continued to express her opinion that my "Versed allergy" was cr*p; despite my being admitted for this.  The surgeon joined in and advised her: "this guy was admitted for a Versed analphylactic reaction, let's just keep him safe".....the CRNA would not sign the modified consent, but agreed verbally to "no Versed"....yeah, I heard this before and still got the drug and ended up in the hospital. I cancelled the elbow surgery and the colonoscopy to remove cancerous growths..a verbal promise from the CRNA obviously means nothing.  Dr. Levy: how can I insure that I won't get Versed for any future surgeries or procedures???? Getting a verbal promise from the anesthesiologist and the CRNA has no meaning; I live in a small town and can't switch providers.  The surgeon says that he has little influence over the CRNAand ffers the surgery with local that he will personally administer.  The endo doc says that she has had similar problems with the CRNA service and that she can't really help me..her office doesn't adminsiter colonoscopy sedation anymore, but she did say that she would do my colonoscopy without a CRNA (without meds)....not her first choice, but she did say  that she would get an unsedated exam before she would let a nurse/crna give her a medication that she was allergic to. Thanks,

Answer
As for the Versed you got before surgery, it is entirely possible that it was a drug error rather than intentional. It does not excuse it, in fact it is even worse, but it might explain the "breaking the promis". As to your current situation, you are between a rock and a hard place. I agree that you should not get Versed. I don't necessarily agree that you shouldn't get any anxiolytic, but that is not the question here. The problem is that a consent form has to be agreed to. There is no reason why the CRNA shouldn't sign it but it is her right NOT to sign it and you cannot force it on her. Clearly there have been problems with this anesthesia service but it looks like there are no alternatives. Since you clearly need the procedures and I WOULD NOT recommend it without any anesthesia, you may have to take the CRNA's word that she won't give it to you (you might even tape the conversation either overtly or covertly) or at least have a witness hear her tell you that. Obviously stress again that you are allergic to Versed (use the word allergic even though technically it is not an allergy) and she won't give it to you.
Just to explain the reaction you had, it is not an allergy (which by definition is an immunological over-response to the antigen). Versed can cause disinhibition in some people which prevents you from controlling your actions, and therefore you act out. Since you have demonstrated on more than one occasion that Versed has this effect on you, you should not get it but it is not an allergy.

Hope this helps,

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston