Anesthesiology/anesthesiology

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QUESTION: Would it be possible to have a endoscopy & colonoscopy performed with out using the amnesia meds such as versed & propofol.  Pain meds definetly but these amnesia meds seem to make me feel anger, stressful, anxious etc for many months afterwords.
I can handle the procedures in an OR but not these feelings of anxiety for long periods afterwords.  I've had versed twice now and each time it seems to take me months to get past it.
Thanks very much for your time.
Regards

ANSWER: Yes it is. Just tell the anesthesiologist, CRNA or your endoscopist that you don't want Versed and they should have no problem with that. Versed is a much stronger amnestic than Propofol and you probably got both so it was likely the Versed that caused your problem. Unless you have had Propofol alone and had the same issues, don't eliminate it so quickly. It's a wonderful drug.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

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

QUESTION: Thank you very much for your valuable time and input.  Actually the only two meds were versed & demerol one time & then propofol & fentanyl another time. Each time afterword I had this high anxiety/agitated level for months so I'm glad to know an endoscopy & colonoscopy done at the same time can be completed with out these two meds. I wonder what other agent the endoscopist might use if not propofol and versed? I guess a strong dose of valium/anxiety med as I'm sure there is considerable discomfort with these procedures!

If I may be permitted to ask a second question... I am planning a knee scope soon under general anesthesia and would like to avoid propofol & versed for this procedure as well.  Is there any reason that can't be done? Or what meds could be substituted for these two?

I also think I'd like to avoid any anxiolytics prior to and up until all prep is completed in OR and they are ready to administer anesthetic for the general. I'm not an excitable person,not much bothers me so I just don't see a need for these pre-op anxiety meds.  

Rather than a general,I've thought about requesting doing the knee scope with a spinal with out the propofol, versed or anxiety meds. What is your professional view on the above?
Again, Thank You for your valued time

Answer
First of all, Valium will likely have the same effect (maybe even longer acting). It is also an amnestic. Versed replaced Valium because it was shorter acting. As for your other question, knee scopes can be done under a spinal, in which case this may not be an issue, but if you have to have a general, there are not many options to replace Propofol. Avoiding anxiolytics until prep is complete makes no sense because there will be no reason to give it if you are going to sleep. The purpose of the drug is to relax you prior to going to sleep. Assuming you are in the US, the only other drugs commonly used to go to sleep are Etomidate and Ketamine and both of those also have negative side effects. I would suggest trying for a regional technique such as  a spinal.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

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Ronald Levy, M.D.

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Associate Professor of Anesthesiology, University of Texas Medical Branch at Galveston. I am a board certified anesthesiologist who can answer all questions related to any type of Anesthesia with the exception of Pain Management.

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