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Anesthesiology/Atrail Tachucardia & Low BP before Fentanyl/Versed Colonoscopy

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Question
Dear Dr. Levy,

Scheduled for colonoscopy with Fentanyl & Versed in 5 days.  I read that these 2 drugs could drop BP.  I already have very low BP.  My daily BP is about 100/55 and lower at night and pulse 66 because I take 12.5mg Toprol XL BID.  Without it I have atrial tachycardia which really reduces my BP.

So, do you think I should take the Toprol am before afternoon colonoscopy?
(risk if tach my BP goes lower; I am nervous about this)
Skip evening before Toprol and morning Toprol?
(risk if tach my BP goes lower)
Or Take 6.25 mg Toprol XL morning of colonoscopy?
Or take the usual 12.5mg in am?
(risk lower BP)

They said if I came in with BP too low they might have to do something else like virtual colonoscopy and reschedule another day.  I wanted a procedure where polyps could be removed because of my family history of colon cancer.

Would propofol be safer for person with atrial tachycardia ?  (usually very short episodes)

Would propofol be safer for person with BP 100/55 and lower?

I wrote to you since I do not want to go through prep in case my BP is too low to begin with for a Fentayl/Versed colonoscopy.

I read that even just the prep can lower BP.

Also, the procedure is done at a clinic not a hospital which uses nurses nor doctors that are trained in anesthesiology and cardiology problems.  They have a good reputation and my husband did very well there last year.

What do you think is best?

Answer
Continue to take your medicine as prescribed unless your doctor tells you not to. Every drug that we give you can theoretically lower your blood pressure. Fentanyl and versed are ok together as long as someone is watching your vital signs. If your endoscopist is uncomfortable doing you in the office, you may need to have it done in a hospital with an anesthesiologist.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-GALVESTON  

Anesthesiology

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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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