Expert: JM Starkman, MD - 8/19/2011

Question
Dear Dr. Starkman,

First may I say "thank you" for providing this service. Second, I want to say that the information I am requesting is for my own information, for future procedures, and not to complain about anyone.

I am a 48 year old woman, with multiple problems: vasculitis, antiphospholipid anatibody syndrome, lupus, Raynaud's, and severe osteoarthritis. I've had multiple surgeries (17)and procedures over the last 20 years and never had a problem with anesthesia. I'm the patient who is happy going in and happy coming out - I wake up immediately and am able to tolerate (crave!) food and drink with no problems whatsoever. I am also allergic to multiple meds, including demerol, morphine and dilaudid.

Last week I was scheduled for an endoscopy, colonoscopy & doppler ultrasound. I developed a severe migraine that morning prior to the procedures but was not allowed to take anything for the pain. The holding room personnel finally did receive permission to give me phenergan IV for the nausea while I was waiting for my procedure to start. When I was taken to the gastro room I was given versed and fentanyl and awoke 20 minutes later to find myself in the surgery wing prep room. I was told that I had been extremely combative and was transferred to surgery for sedation with propofol.

My question is this: is there any type of reaction that can occur between phenergan, fentanyl and versed? The phenergan is the only thing I can think of that was different from other times I've been sedated with fentanyl/versed. I was just so surprised (and embarrassed!) that this happened and do not want to repeat the experience. I also want to mention that I underwent an emergency colonoscopy in late January (heavy bleeding in the colon)and had no problems at all with the fentanyl/versed. This was the first time that I had been sedated at this particular facility.

I know that I have additional procedures in my future and do not want to have the propofol again if I can avoid it. I don't like the "after" feeling at all.

Many thanks for any help you can provide.

Robin

Answer
Not  knowing anything else about the particulars of your experience, off hand, it sounds like the problem was with a staff that didn't know how to handle a mild case of dysphoria associated with multiple medications.  The meds you mention are often given together or at least in close approximation--time wise-- and don't normally provide a problem like the one you describe.  In general, mixing large or moderate doses of multiple meds is a bad idea; I prefer to stick with one or two  myself.