Thursday, December 15, 2005

Introduction

Why Flag Versed (Midazolam) ?

Here is a list of the complaints about Versed we commonly encounter:

* Too often, the drug is used in a sneaky or furtive manner. Every manner of lying, cheating and BS-ing has been reported by people who unwittingly received this drug. Knowledgeable people, including medical people, have been given Versed after clearly refusing it.

* Versed is NOT a pain medication. The main effects are AMNESIA and patient compliance. Many patients feel they were mishandled, given inadequate pain management, or both. The impression is that the medical staff tries to hide behind the amnesia the patient is expected to have.

* Paradoxical reactions including anxiety, delirium and aggression. This includes patients attacking or trying to leave. They lose touch with reality, not knowing where they are or what is really occurring.

* Some patients experienced a distorted, nightmarish version of their procedure accompanied by feelings of abandonment and panic. This is often accompanied by the next item:

* A kind of sleep paralysis - patient is aware but cannot move and cannot communicate.

* Amnesia did NOT take place for some patients. Patients recall a bad experience!

* Some patients report a "creepy obedience" overcoming them.

* PTSD. Many patients report symptoms of Post Traumatic Stress Disorder after having this drug.

* Weird panic or anxiety episodes ("flashbacks") for some time (weeks, months, years) post-op.

* Long term memory disruption. Memories formed prior to the use of Versed are lost. Some people are unable to retain new information or complete tasks.


What is Versed?

Versed (Midazolam) is an amnestic. It is commonly administered in combination with anesthesia before and during surgery. It is also commonly used for minor procedures like colonoscopies so that patients won't remember pain and discomfort. However, that does not mean that those sensations will not be experienced.

Why be concerned about Versed?

If you are a person who wishes to be involved in your medical care, want to interact with your treatment providers, and want to be as aware and alert as possible during procedures, then you will want to be aware of this commonly-used drug.

How would you feel if you were given a drug, without your knowledge, that wiped out any memory of events that occurred over a period of hours?

A person who is under the influence of Versed can function, and can even carry on a conversation, but will remember nothing once the drug wears off. The use of Versed can open the door to abuse. If there is mishandling of the patient during procedures the patient will have no memory.

We are not saying that people should never be anesthetized, or that sedation should never be an option, but rather that:

* One should be given a complete description of what is going to be done to them. If Versed (conscious sedation) is to be used, the patient should be aware of the amnesia that will result.
* When possible, you should have a choice about being awake for any procedure or part thereof. We take exception to being denied a choice in those cases where one exists. One reason we have this site is because so many people report being deceived.
* Attention should be paid to the fact that some people find anesthesia very upsetting and may prefer a few minutes of moderate physical discomfort to a longer period of mental discomfort. Versed appears to cause PTSD in some people.
* Having a bad experience blocked from long term memory is not the same as never having had the experience in the first place. We think that if they have to make you forget, then they are not taking adequate steps to manage pain and discomfort.
* Versed is not a requirement for surgery. Medical professionals should be completely honest about the effects, and not try to trick or coerce a patient into having it. It should not be used solely for the profit or convenience of the medical staff.


What can you do?

Watch out for these commonly used phrases:

* "I am giving you something to relax you." This is too often an understatement, given the frequent side effects. This statement also completely avoids mentioning the amnesia Versed causes.
* "You will be given Conscious Sedation." or "You will be awake, but won't remember anything." This means they probably want to use Versed.
* "You will be in La-La Land." How you can be anywhere you don't remember beats us! "La-La Land" would be more like having a large dose of pain killers - you would be awake but not care. With Versed you will be functional but won't remember a thing.
* Beware of "Most People..." When you have a choice with your anesthesia, you should not feel pressured to make a decision based on what "most people" receive.
* "You are not a Doctor " So what? That does not make you uninformed. For all they know other doctors (your primary care physician for starters) may have already told you enough to make an informed decision. Besides, this is no excuse for pushing you to have an amnesia drug!

Insist on answers!

* Remember that anesthesiologists are not employees of the hospital, but they have no problem hiding behind hospital rules when there is a problem.
* Keep in mind that they are working for you, so ultimately YOU are the boss. Most of them will not volunteer anything, so you must be prepared to ask them very specific questions, and be very assertive. A patient advocate, who can be a caring friend or relative, should accompany you to all appointments and procedures and take notes.
* Be sure to find out what your financial liability will be if you are not satisfied.

If you aren't happy, complain!

There are concerned people out there who will accept your feedback. At least we like to think there are a few. They can't read our minds. Complain first to the hospital. They may ask you to put it in writing. Do so. That way there is a record of your complaint. Then, talk to your anesthesiologist. Chances are, he/she works through a group. If the anesthesiologist does not respond, try going to the associates group.

If someone botches a repair job on your car people don't fault you for complaining. But many people feel bad about complaining to a doctor or a hospital, even though they are working on something far more precious - YOU. Don't be intimidated!


Personal Accounts

Kirt's Account:

I had bilateral hernia surgery with laparoscopy. I knew I was facing general anesthesia, but I fell hook line and sinker for the 'I am giving you something to relax you' line before the surgery.

I had what seemed like a good conversation with the anesthesiologist and was feeling like I could trust him, so I thought 'OK I will be a little groggy, but conscious until he puts me to sleep for the main event'. No mention of conscious sedation or Versed was made. Just after I reached the operating table I realized something was happening, and then my memory disappeared in a roar of static.

I awoke to discover that not only had I been put to sleep for the main event, I had even been excluded from the prep.

When I later complained, I was told "Most People are very happy to wake up and have the procedure over with". Well I wasn't, I was livid, and when I was told the above I should have said "that's fine for them, but what does it have to do with me?"

It has been eight months since the surgery and I still feel taken advantage of, treated as if I was a five year-old, and yes, raped of my memory. I cannot see how a trained MD or anyone can justify the withholding of fundamental information like this. Even when I confronted him several weeks after the surgery he still tried to avoid saying I had been given Versed, until I finally said 'you gave me Versed didn't you?' I can only think that there must be a problem with this drug if they don't want to tell you they are using it.

Worse yet, the anesthesiologist's response to my questioning him was to lecture me about how I had to 'trust those who know what they are doing', and told me that I was one of those people who wanted to know everything. Personally I will never trust another anesthesiologist in my life. I wish I had said that, but I was still so shaken from my original experience that I just listened, dumbfounded.

While the surgery was technically successful I will always regard it as a failure because of the above.

Mary's account:

I went in for out-patient abdominal surgery. I had had several surgeries in the past and am not squeamish about surgery.

Prior to being wheeled down to surgery, I was told that they were giving me "something to relax me." I recall getting in the chair and going part way to the OR, but that is where my memory stopped. I have no recall of meeting the surgical team, getting onto the table, etc.

When I awoke, I was very agitated and upset. I remember wondering what had happened to me, with the sense that something very bad had happened but I couldn't remember what. I had finger-mark bruises on my upper arms and several other, larger bruises elsewhere. My neck hurt so bad that I was unable to turn my head for 24 hours.

I was extremely distressed that the hospital had not told me about the effects of versed and experienced severe anxiety for months about the memory gap. I had to go to counseling and was put on an anti-anxiety medication.

When I complained to the hospital, I was patronized and treated like a little kid. I did not feel as if they took me seriously.

Weeks later, I went to use my instant cash card, put it into the machine, and went to enter the PIN number, when I realized, much to my shock, that I had absolutely no idea of what the number was. I had used the same PIN for years. It never did come back. No doubt there are other 'lost' things, but I haven't recognized what they are.

Tim's Account:

I had bilateral hernia repair in September of 2004. The original plan was to use MAC ("Monitored Anesthetic Care"). The anesthesiologist did not explain the effects of Versed and did not explain that the MAC would be initiated in the holding area before I was wheeled to the OR.

The drug was not named. I was only told that from my perspective, the experience would seem like general anesthesia. This did not make sense - it seemed contradictory. The "A" word (amnesia) was not mentioned. I have had numerous operations in the past and my experience led me to assume that the main event would occur in the OR. The anesthesiologist introduced the Versed into the IV while I was still in the holding area. I asked what it was and the reply was simply "benzodiazepines." I know what benzos are and thought I was getting something like Valium. I was shocked when, from my perspective, I found myself in recovery what seemed like a few minutes later.

After surgery I was told that I had a bad reaction to the Versed so they ended up putting me under. The nurse in the PACU said that my legs were shaking and this is why they used general anesthesia. The surgeon's report stated that I was moving my extremities and would not be still. I was also told that I was unable to follow instructions. This is disturbing since I am not squeamish about surgery nor have I ever been out of control like this.

When I later spoke with my anesthesiologist, she used a lot of euphemistic baby talk, describing the amnesia as "making you forgetful" and describing the general anesthesia as "we had to make you more sleepy". My surgeon dodged the bullet saying "We're always ready to do general when we do MAC". This is all BS. Looking back on the experience, my wife and I agree that the anesthesiologist was very deceptive.

I am an electrical engineer. In the weeks after my return to work, I found that I had no recall of certain details of my job. We are very procedure and detail oriented. I found that certain blocks of information seemed to have simply disappeared from my long term memory. What else have I forgotten?

For three years post-op I experienced flashbacks of anxiety that occurred randomly - while at work, while driving, while teaching. These were accompanied by an odd sensation of trying to recall a memory but it refused to come into focus. Very strange, very unsettling - and I never experienced anything like this before exposure to Versed.

I was in my 40's when this happened. I have had several surgeries, numerous emergency room visits and my share of dental work. I never had a bad outcome or cause to complain until my Versed episode.

View Comments pages 2,3 and 4:

http://www.blogger.com/comment.g?postID=113469632967363416&blogID=19908598&isPopup=false&page=2

http://www.blogger.com/comment.g?postID=113469632967363416&blogID=19908598&isPopup=false&page=3

http://www.blogger.com/comment.g?postID=113469632967363416&blogID=19908598&isPopup=false&page=4

670 comments:

1 – 200 of 670   Newer›   Newest»
Peter said...

I was dissatisfied with Versed being adminsistered to me without disclosure of its amnesia effects, for my out-patient surgery in 2004.

The anesthesiologist did not inform me that Versed would cause amnesia. He said to me, "You wouldn't want to rember the surgery because it's frightening." I replied to him, "The surgery won't bother me." Then without informing me that I wopuld be given Versed the anesthesiologist simply said to the nurse, "Versed" and she replied to him "yes." After the Versed was adminiustered the nurse said to me, "You won't remember what you're saying." She was right.

It was wrong to adminster the Versed to me because I explictly told the anesthesiologist that the prospective memory of the surgery would not bother me, and by his actions he gave me no choice about his adminsitration of this amnesia causing drug.

As long as I am not in physical pain from a given medical procedure (which can be accomplished with by anesthesia), I do not want to be drugged into amnesia about the procedure.

I feel my privacy was violated because as a result of the Versed I was having converations for whcih I have no recall.

Peter

-Tim said...

Peter:

Thanks for your input.

It occurs to me that we need to get lawyers and sympathetic medical professionals involved.

I will never have another procedure without speaking to the anesthesiologist in advance, and I will not work with them if they do not agree to cooperate.

I am disturbed by the pattern that is emerging around how versed is used. You have a right to choose.

Peter, these people were outright abusive. I would call some lawyers and see what they have to say.

-Tim

Kirt said...

Peter,

Well, join the club - next time I keep my hand on the IV tube, ready to pinch it if need be (I'm serious).

I am curious about two things if you don't mind sharing - what were you having done, and in what general area of the country are you located?

Did you complain to the hospital or the surgeon after? If so what response did you get?

The worst part for me, was that I knew what Versed was, and they got it into me by lying - 'something to relax you'.

Gus said...

I am a 65-year-old man. In October 2005, I had two procedures; both involving Versed. The first was a routine colonoscopy. I was told by a nurse (not the one involved in the procedure) that if I wanted to remember the procedure I could refuse Versed, which I did, assuming otherwise I would be asleep. I am well educated and curious and wanted to see the "movie". It turned-out to be a fascinating experience: saw the doctor remove three polyps, had only moderate discomfort and able to ask the gastroenterologist questions during the procedure. Two weeks later I had a serious surgical procedure: removal of a pituitary tumor. This was my first operation requiring general anesthesia. Minutes before being prepared for surgery, I met the anesthesiologist for the first time. He said he would give me something to relax me, never being told that the drug would cause complete amnesia from that moment until I woke up hours later. What was even worse was when I found out that I would be conscious and not remembering what I said or did until they gave me general anesthesia. I had assumed I would be conscious and than unconscious (so much for assumptions!) While it is true that some people, perhaps the majority, prefer this treatment, I do not. I think there is something unethical with doctors not explaining the use and effects of Versed, which I later found out, was given to me. Up to that point, I had never taken a tranquilizer-like drug in my life and resent having my brain and subconscious fooled with. When I asked one of my doctors what I said or did during this "conscious sedation", he said, "I was not funny". Following surgery, I had a very large bruise on my ankle and since this was a head operation, \I asked the neurosurgeon about it. He said it was probably for anesthesia: his explanation sounded strange to me, but what could I say since I don’t remember anything. While the operation appears to have been a success, two months later I am still feeling the effects of Versed: changes in breathing and a peculiar kind of anxiety, and God knows what else. Perhaps the surgeons, nurses, and other doctors in the operating room don’t want to be bothered with patients asking questions or having them being aware of what’s going on before general anesthesia. I think the patient should have the choice about taking this drug. Perhaps it should be unlawful to administer these kinds of drugs without the full knowledge and permission of the patient. If I ever need another operation, which I pray I never do, I will make it very clear that I not want this kind of drug and hope they listen.

Kirt said...

Gus,

I also had a routine colonoscopy without sedation (except for low dose of demarol) and found the experience to be positive. Like you (I am an electrical engineer) like knowing what is going on, and will gladly trade some discomfort for knowledge.

Also much like you a couple weeks after the colonoscopy I had surgery requiring General Anesthesia (bilateral hernia done via laparoscopy). My experience parallels yours to an uncanny degree. I won't repeat all here, as I have already posted it.

All I can say is that a lot of peopel almost faint when I mention the colonoscopy. Well that was one hell of a lt easier than being put to sleep.

jwb said...

I just got finished with abdominal surgery myself and Versed was used. I must say the experience was completely positive -- I asked a bunch of questions about the drugs that I was going to be administered, and what their effects would be. That was eight hours ago and now I'm a little groggy, but my short-term memory is working correctly (I think). I am happy with the effect, but, unlike you people, I was fully informed as to the drugs I would be receiving and their effects. It sounds like you good people did not receive similar treatment from your providers. I'm very sorry to hear that. I hope that you are able to find health providers in the future that you can trust more.

-Tim said...

JWB:

I'm glad your anesthesia seems to have worked well for you and they appear to have been completely honest with you.

What disturbs me is that there is a big drive to use Versed and also a big drive to be deceitful about it.

I think that they know damn good and well that people do not like the "A" word - "amnesia". This is usually associated with old age, head trauma and other bad things. I don't expect anyone to ask a patient if they'd like some amnesia with their surgery.

I think they know damn good and well that if they properly described versed and it's effects, admitting that "this drug will produce profound anterograde amnesia. You will be aware during your operation but won't be able to remember anything" a lot of people would call them on it immediately. If they had been this up front with me, I would have refused such a drug, even if it meant cancelling the surgery.

As Gus said, I find the way I was treated to be unethical and I resent having my brain and memory fooled with.

Darlene M. Caban said...

My complaint about Versed was that it DID NOT WORK on me!

I had a cardiac cath on Jan. 6, and I needed 5 doses of it, plus the pre-op Valium, just to get through the 30-minute procedure-- and I remember yelling "Ow! Ow! Ow!" at least twice-- once when the cath was inserted, and once when the femoral plug was being put in. After all that Versed, they expected me to sleep for 4 or 5 hours-- and I was awake after 2 hours, and having a conversation with the heart surgeon, who had come into my room just to observe me-- he never expected me to wake up and rationally discuss the situation! My cardiologist came in and he, too, was stunned to see me awake and talking.

If those people think they're using Versed on me with the mitral valve replacement surgery I'm having on Jan. 25, they're out of their cotton-pickin' minds! I am going to report the problem with Versed to my nephrologist (I'm a dialysis patient) and have Versed added to the list of drugs that don't work on Dar!

--Darlene Caban

marsenvoy14@aol.com

michelle said...

I've received Versed twice. Once 4 years ago for a D&C after a miscarriage. I asked to not have general anesthesia, my doctor agreed to sedation. No one explained that they were going to cause amnesia. I have PTSD after years of child abuse, and was left in an incredible amount of mental pain. I stopped eating for 8 weeks, lost 40 pounds, couldn't sleep, all over the fact, that I was concious and cooperated w/ a group of people that I didn't know and wouldn't remember. I couldn't convince myself that nothing bad happened. No one fully explained what sedation meant.

I had sinus surgery in December. I understood that I had to have general anesthesia. I fought the entire pre-op time trying to find out what was going to happen, but no one had time to talk to me. The anesthesiologist came in and quite evidently didn't want to talk to me. He finally said he'd give me a sedative prior to going back to the OR - once again it was versed. I had expected to be able to see the OR, to see the people involved in my care and didn't. I later found out the dr. I talked to wasn't the one who administered the drugs, my mouth was black and blue from the LMA - I had numerous abrasions and cuts on the inside of my jaws and the roof of my mouth. Both arms were bruised.

I am not a child and expect to be fully informed - again, I can't get past the thought that the reason they wanted to make me forget is because something bad happened. Intellectually, I understand that's not probable, but I feel differently.

I would have adamantly refused versed if I had been fully informed.

Personally, I feel that I was violated - not much different than being molested as a child.

Michelle

-Tim said...

Michelle:

Once again, we see the clear and obvious pattern of them willfully avoiding explaining the amnesia that versed causes.
It is bad enough that some people in the medical community callously and arrogantly treat people this way. Now you come along, especially vulnerable with PTSD, and have to endure this mistreatment. Great. Just great.

Michelle, *I* can't convince myself that nothing bad happened to you either. Your feelings are logical and normal. The abrasions and bruises you describe are likely evidence of mistreatment, or at least rough handling. The truth is, some people freak out on Versed (I suspect that I did) and a bad medical crew (one that is poorly trained or just doesn't give a damn) is likely to just get impatient and take it out on you.

The anesthesiologist "quite evidently" not wanting to talk with you is a major red flag. That was time to get your dander up.
In the future I will always bring my wife with me to surgery. She is well briefed on all of these issues and knows what I want out of the experience. She takes notes and I think my anesthesiologist was a bit surprised and looked a bit nervous when my wife wrote down her name. Between the two of us we will ask questions and press them if needed.

In the future I plan to speak with anesthesiology a day or more before surgery. I will TELL them how I want things done. I will explain my knowledge and experience with all of this and let them know I am not a person to be screwed with. If I get a bad vibe, I will look elsewhere.

For my hernia repair, I did not use the first surgeon I interviewed. I got a bad vibe and went elsewhere. Obviously, I will never use the anesthesiologist again.

We are all used to the pre-Versed days where there was none of this amnesia B.S. and we expect to recall the operating room - especially if we are not put under for the procedure. I had two hand surgeries in the '80's under local - my experience was fine. During the second surgery, PER MY REQUEST, they did not even administer Fentanyl until I mentioned I could feel some pain.

For whatever reason(s), they really seem hot to use Versed on us. I think they rely on people either having no surgical experience to begin with or they have expectations based on the pre-Versed world. It really gets my attention that they are both eager to use Versed and also be very deceptive about it.

Obviously, some of these medical folks don't give a damn what we want or how we feel about it.

Also odd that the doctor you I talked to wasn't the one who administered the drugs.

I also can't get past the thought that the reason they want to make people forget is in case something bad happens. And I think it is common for people to freak out or whatever and it is easier for these lazy, inconsiderate jerks to block your memory so that the can then treat you any way they want to. This Versed business smells like a kettle of fish.

I am in total agreement with you that we are not children, we should be completely informed, I feel violated, and I will also adamantly refuse Versed (and anything like it).

I suggest you speak with an attorney. Also, COMPLAIN to as many relevant people as you can. Let the hospital, etc. know how you feel. Write up the doctor(s) on www.ratemds.com.

Anonymous said...

My 18-year-old daughter was given Versed yesterday, along with Decadron and Valium, to manage the extraction of her 4 wisdom teeth. The dentist did not bother to share the details of the drug cocktail in advance (and I didn't think to ask as I was told she was just being given 'mild sedation'), nor warn us of potential adverse reactions.

30 mins. after the procedure, she awoke completely hysterical -- uncontrollable crying and screaming/yelling. This continued for four hours. She tnen became suicidal -- she scratched her wrists completely raw and went stumbling out of the house with scissors in her hands (which we fortunately were able to remove). She stumbled around the neighbourhood for an hour trying to run in front of moving cars(with us following on foot and by car) and returned home to collapse. She tnen became exceptionally angry and would not allow anyone near her or touching her. She refused to allow us to take her to hospital emergency.

The recommendation of our family doctor was that we either monitor her "day and night" for 24 hours or call the police to come with a straighjacket and admit her to a psychiatric facility. We chose to monitor her due to the potential trauma of option B.

Following all of the above, she fell asleep for an hour.

On awaking, she had no memory of what had taken place for the entire day. No memory of having clawed herself, no memory of being at the dentist, etc. While the hysteria had subsided, she was exceptionally emotional and continues to be this way 24 hours later.

I spent considerable time today researching the adverse reactions of this incredibly nasty drug. I personally think it should be banned. It is close to being criminal that it would be administered to a child with no warnings to the parents or patient about the potential adverse reaction. I am appaled but want to thank you and others who have taken time to share their stories and to shed light on such a vile drug.

-Tim said...

Thanks for your input.

I too would like to see this drug banned. It is obviously unpredictable and is unstable enough that a good many people have severe reactions to it.

They should not be using drugs that affect memory. Versed is supposed to be short acting, but obviously it lasts a long time with some people.

It is odd and disturbing that they are so eager to use Versed and they are so sneaky about it.

I would speak with a few lawyers and other doctors. I'd really try to stick it to this dentist if I were you.

kirt said...

I can't believe that the dentist allowed your daughter to leave his office in the condition you describe. They probably shoudl have called 911. I also wonder about mixing Versed and Vallium.

Jackie said...

I too was victimized by the non judicious application of Versed. I knew nothing about this drug, my last surgeries were in the 1980's. I did wonder why the anesthesiologist didn't call me the night before. When I called the hospital, they said he would see me before the surgery. Odd. Well he and his male nurse did show up minutes before show time and gave me something called "Vitamin V." The reason I wanted to talk to the anesthesiologist so badly is that I can't stand a loss of control, so no General Anesthetic. I explained the problem to them so they promptly gave me something much MUCH worse. Versed. At least with the general you are not awake and talking. It turned me into a compliant zombie without a will of my own no matter how much I fought the drug. It was a real life night mare where I was trying to stop them and was completely helpless to do anything other than what they ordered me to do. They did not ask if I wanted this, they did not describe the drug except as a "muscle relaxant" They did not even name the drug. I had to go down to the hospital and demand the names of the drugs they used. Even then it was not listed on the MEDS sheet, it was handwritten in tiny letters at the bottom of one of the pages. Those dirty so and so's destroyed the sanctity of my person with impunity. I may never get over this assault. At least with a rapist you can talk to sympathetic police who will try to catch him and send him to jail... Where do you go with a medical attack?

Jackie said...

By the way, the reason I was in the hospital was for a BROKEN ARM! Big deal. I wanted to stay awake and watch the surgery, just as I was allowed to do in the 80's. Now I am ruined. It's been 7 weeks and I just keep getting more and more angry with each person who was involved in this disaster. The hospital staff, the nurse, the doctors, etc., just tell me that they know best and I should get over it and get on with my life. Quit obsessing over them tampering with my mind. I wonder how much longer I can go to work. My gp wants me to take Prozac, but can I trust that THIS drug won't do things to my brain. Why should I have to pay for drugs and therapy just to recover from 2 hours of loving "care" from the hospital?

Anonymous said...

Hi There

It sounds like you went in for a procedure with different expectations, and were perhaps not informed as to what was going on.

My experience with Versed was great. However, I went in knowing what it was AND my nurses/doctor were very upfront with everything they were doing the entire time. I was given a cocktail of Demerol/Versed/Benadryl for an upper GI procedure. I can remember being quite warm and comfortable after meds were injected into my IV. I remember the doctor walking in and saying "he looks very aware" (I think that is when the Benadryl was added).

I was very nervous about the procedure and drugs, as I had not even ever had an IV. It all went great. Other than not remembering much of the procedure, and telling the nurses I was a Jedi knight and had hidden pirate treasure, it was great.

As with any procedure it all comes down to the doctor/patient relationship.

-Tim said...

Those of us who are complaining - mad as hell even - have experienced some combination of being lied to (one way or another), treated like a kid (or worse) and generally getting an attitude from unprofessional, uncaring, arrogant and self-centered practitioners. Kirt here is concerned with how versed is being used and the consistent deception that accompanies versed use. I go further and insist that it is a dangerous, unpredictable, unreliable drug that probably should *never* be used. The eagerness to use it far more than merely disturbs me. What the hell are they teaching people in anesthesiology school? To just assume people accept their memory being blocked is stupid at best and arrogant and self serving at worst.

jackie said...

I think Anonymous could be the key reason that the doctors are willing to jeopardize the rest of us, and their almost desperate zeal to give this drug. I resent the medical staff trying to use me as the cheap entertainment. It took me 2 months to get over the rage and obsession over Versed. I am still very VERY angry, but I don't think I will snap now and end up in a mental hospital. This drug whould be banned. I can't figure out why the mental disintigration has not been listed in their side effects or contra-indications for this drug.

Jackie said...

Please report you adverse reactions to www.fda.gov/medwatch/ this is the only way we are going to stop this.

jackie said...
This comment has been removed by a blog administrator.
John said...

I noted that virtually all comments are by the patient. This time it will be by her spouse.

On March 14, 2006, my wife under went an EGD procedure. The Doctor used a powerful sedative, VERSED. She was released to me still under the effect of this drug. VERSED causes a dense amnesia which blocks all memory of the procedure.
During the first 2 – 3 weeks following she had trouble finding new locations from typical directions. If she had been there previously then she could find it again. Not so with a new address. IE: her cognitive skills had been damaged. Not just her short term memory. This appears to be the result of Encephalopathy Hypoxia

Hypoxia: Starved for oxygen
Encephalopathy: Generalized (i.e., not localized) brain dysfunction marked by varying degrees of impairment of speech, cognition, orientation, and arousal. In mild instances, brain dysfunction may be evident only during specialized neuropsychiatric testing; in severe instances (e.g., the last stages of hepatic encephalopathy), the patient may be unresponsive even to unpleasant stimuli
The VERSED caused total amnesia lasted for several hours after reaching home. She did not know her husband’s name, for example. This is quite contrary to advice from the endoscopy center.

From the anecdotal info on the internet, there are hundreds (maybe tens of thousands) that have had adverse experiences with VERSED. It appears Karen went into respiratory arrest due to a 400% plus overdose and Cranial Hypoxia occurred. This the diagnosis of two neurologists in two States.

The death rate is one per 3300 EGD procedures. When this procedure is performed in a hospital setting with an anesthesiologist present the mortality rate drops to one in 250,000 procedures. Clearly, the stand alone surgical-center for endoscopy / colonoscopy procedures are killing patients. My wife narrowly escaped. But not without permanent injury to her brain. BTW I think several are mistakenly assigning memory problems to VERSED when they are actually due to brain injury. As you might not know, the practitioner has only 120 seconds before irreversible brain damage and death will occur. Some call this a code blue.

The wide spread use of VERSED by unqualified nurses is very disturbing. Doctors want to perform a procedure while you will be mostly conscious and compliant guaranteed but it can be painful and might leave mental scars. So they put you through all the pain but block your memory of the pain. This substitution of VERSED with synthetic amnesia instead of anesthetic also keeps the patient from testifying later about anything wrong because any medical errors and mistakes are also blocked from memory. Nice.

I am preparing for a legal battle. The great white wall is starting to sense it.

This unexpected total lack of recall caused Karen a great deal of anxiety for over three months. The doctor or nurse typically describes VERSED as, “We are going to give you a little something to relax you.” The dense amnesia it will cause is never discussed. The conscious sedation is not explained.

The patient is left without any idea what just happened to him/her. The errors of the physician can not be contested by a patient with dense amnesia about the total procedure. Also, patients are not aware that if they do survive the procedure without injury, their recall of the procedure will still be non-existent.

Karen awoke not expecting such a total loss of recall. It has made some PTs anxious and to have profound worries about their sanity. Some patients have required extensive (and expensive) psycho therapy and counseling.

In Karen’s case she worried that the VERSED had set off a chain of organic events that would end with an Alzheimer’s Disease diagnosis. I have never seen her so anxious. When she found out VERSED was also a Date-Rape drug she was really worried.

"I could have been raped while in the recovery room and have no recall."

Fot some reason unknown to me, I was barred the recovery room.

Never-the-less, I strongly suspect that the good doctor was working hard to resuscitate Karen and save her life. Brain damage was not in his mind at that moment.

I also suspect that is why he was so short and anxious when he did get to the consultation room.

So, if you or your spouse are having short term memory problems see a good neurologist and ask about a mini-mental test. You might be shocked. Don't blame yourself or spouse as,"You are just having a bad reaction to the drugs used."

Fully 1/3 of all Cranial Hypoxia cases are due to mistakes in anesthesia. (VERSED)

Be certain to read up on HIPPA. I have used it to secure damning information as I prepare for a battle.

Jackie said...

I actually do remember all that happened to me AFTER they tried to give me amnesia with Versed. However, the medical staff argued with me and put forth THEIR version of events. That is when I learned of the attempt at amnesia. They said and I quote "You can't possibly know what we did to you because we gave you something to give you amnesia!" I was absolutely STUNNED that they would first give me a drug like that and secondly LIE to me about what happened to me under their "care." I was COMPLETELY compliant with whatever they wanted to do with me, regardless of the amnesia not working. If they had told me to kill myself I would have done so. I had absolutely no will power which was extremely upsetting. So upsetting was the powerlessness that it caused PTSD etc. that I have previously discussed. I also suffer from nightmares involving loss of control. This is such a bad drug I can't believe that the FDA allows its use, even on children. Your wife has every reason to feel the way whe does.

Ron Kelly said...

I had prostate surgery (TURP) 12-2-2002. I had no idea what Versed was or what it would do, etc. I did know they didn't want me to have regular anasthesia for fear I would vomit during recovery. They most certainly did not want that because it would aggravate internal bleeding. So, the Versed was used. Mentally I equated it with an anesthesia that wouldn't cause vomiting and that was it.
I was in recovery for about 5 hours because of internal bleeding and I went hypothermic. I can remember events in recovery okay, but the problem started after I got into my room. I carried on lengthy conversations, did and said things that I totally cannot recall, no matter how hard I try.
Several years ago I suffered temporary amnesia from a blow to the head. I lost memory of events occuring in the hospital for a couple of weeks, but I DID regain that memory. With the Versed memory loss, I never did regain the memory, and that was 4 years ago.
I had to have a repeat prostate surgery in just 4 months, 4-1-2003. That time I simply wrote "NO VERSED" on my permission slip at the doc's office before the surgery. I had no hassle from anyone. My doc is a great guy and went along fine with it. That surgery was great, if you can call any surgery great. I knew everything that was going on- no pain because I'd had a spinal- was able to talk with the doc when he was finished and can remember even what the operating room looked like.
Then about 2 years ago, maybe less, I had a colonoscopy. Again I wrote "NO VERSED". That doc didn't like that at all and called me personally to tell me so. I went in to see him and told him I'd already had the TURP with no Versed and made out fine, so he agreed. I did suffer a lot of pain during the colonoscopy because he couldn't get through the colon, but at least I can remember it! What was better yet was that I was on my feet almost immediately walking around, chatting with the nurses and a nun in the hallway, and did not have to lay around in a haze after I got home. My wife just had one and was in a haze all day long.
As for me? NO THANKS! NO VERSED FOR ME! I have enough memory problems without adding to it.
I have to admit that nearly everyone I talk to, even nurses, absolutely love having Versed. They look at it like a joy ride. That's fine. I don't like having blank spots in my memory and don't want anymore of anything that promotes it.

Sincerely,
Ron K.

Anonymous said...

Well, one more story on Versed. I was given this drug during foot surgery in an ambulatory surgical suite. Surgery was at 2:00 p.m., but I was unable to leave until 9:00 p.m. I woke up screaming, fighting, trying to jump off the gurney. I was going in and out--sometimes aware--sometimes not. I remember trying to punch out a nurse, trying to bite someone, etc. When I finally became somewhat rational, I had been tied to a chair; my elbow was skinned, etc. The effects continued for about 10 days, headaches, dizziness, disorientation. This is absolutely the worst drug I have ever encountered. If the goal was a speedy recovery, it had the opposite effect---I needed their attention for hours! It is a miracle that the surgery was a success!

Anonymous said...

i was given versed for and endoscope/colonoscopy. I had NO anxiety prior to the procedure but have been extremely disturbed by the amnesia it caused and an angry this effect was not explained to me. As a layperson, 'consious sedation' does not mean 'amnesia' so where was my informed consent. I have lost so much faith in the medical care system over this i think i always will be anxious in the future. i will NEVER allow these drugs again.

John

Anonymous said...

I was given versed for a colonoscopy two months ago. I can't get the anger and depression out of my head. I must have another colonoscopy in a year and except for saying "no" to the versed,I don't know what to ask for instead. I don't want the pain but I certainly want to be relaxed and unafraid but especially awake.

-Tim said...

Anonymous said:

"If the goal was a speedy recovery, it had the opposite effect---I needed their attention for hours! It is a miracle that the surgery was a success!"

Anonymous said:

"I had NO anxiety prior to the procedure but have been extremely disturbed by the amnesia it caused..."

The folks who push Versed seem to have not heard the saying "If it ain't broke don't fix it!"

John said:

"... angry this effect was not explained to me. As a layperson, 'consious sedation' does not mean 'amnesia' so where was my informed consent."

I am amazed at the pattern of sneakiness involved with pushing Versed on people. I agree with you that your doctor used double-talk to rob you of your "informed consent." Same thing happened to me. "Angry" only begins to describe my feelings.

Anonymous said:

"I have lost so much faith in the medical care system over this i think i always will be anxious in the future. I will NEVER allow these drugs again."

Same here. How can we have faith in proven liars?

Erica said...

I never wanted to know what occured during my surgeries. My medical condition was less than pleasant, and I only cared that the problem was rectified. However, the lasting effects of Versed have caused me to reevaluate my thoughts. What are left of them, that is.
In 1999-2000, I was an award winning Sr. site manager for the world's largest management company. Then, I had 10 surgeries, 8 of which were done using Versed. Suddenly, I was extremely anxious and even asked to be demoted because I could no longer manage two sites. I had no idea why the work that had once been so easy was suddenly impossible for me to complete. I could not focus on routine tasks and became easily irritated and excessively distracted. Over time it became apparent that certain memories were simply gone.
In 2003, I left my employment to move with my husband. I thought that being a stay at home mother would be easier, and it was for a time. Yet, over the last four years, the problems have gotten worse, not better. It may be because I have time to try to reflect on my life and some fairly large pieces are missing. I agree that these missing memories cause anxiety. Sadly, it's not just memories from the time of the sugeries that have been erased. I do not remember the first year of my daughter's life. My husband finds it hilarious when I think that one of our children has done something for the first time and it turns out it is the third or fourth time. I simply don't remember. I don't remember large parts of high school and college. I don't remember much of my childhood. I can handle that fairly well. What I cannot handle is my distractablilty and irritablility. I seem to get into a rage at times and then become extemely sad and withdrawn afterwards. I live in fear that I will hurt one of my precious children. In researching these issues, I have found that I have all of the symptoms of temporal lobe ADD, and I have an appt. to see a doctor this week. I know that Versed played a role in my problems since they were not present prior to the surgeries.
Recently, I learned that Versed was administered to my daughter prior to some dental work last year. Luckily, I haven't seen any lasting effects, but I warn all parents to force the dentists to tell you exactly what they are giving your child.
In closing, I would like to thank Tim and Jackie for contacting me after I posted on another site. Knowing that others have had the same experiences at least gives me some sense of peace.

Anonymous said...

Tim,

Since leaving my original comment a few days ago, I have done a little more web research on unsedated endoscopy and colonoscopy. What I have found has only increased my anger at the 'informed consent' procedure that I received. I now know that studies comparing sedated versus unsedated procedure indicate that the majority of people who have the procedure performed unsedated say they would do it again that way.

Audit of sedated versus unsedated gastroscopy: Do patients notice a difference?

Jonathan Peter Watson, 1*MA, MBBCh, MRCP, PhD, FRACP, Carmel Goss, 2RN, Grant Phelps, 2MBBS, FRACP

Abstract Unsedated diagnostic gastroscopy has become widely accepted as a diagnostic procedure which avoids the risk of an anaesthetic... Patient tolerance was analyzed in various categories including degree of comfort, degree of pain, ease of breathing and willingness to repeat the procedure under the same conditions. The perceived comfort rating was compared between the patient, the endoscopist and the endoscopy nurse. A total of 100 consecutive patients were evaluated; 55 chose to be sedated and 45 were unsedated. Of the 100 patients tested, 88% stated they would have the procedure the same way if a repeat procedure was required. There was no significant difference between male/female or sedated/unsedated patients. The most important consideration for patients who chose to have the procedure unsedated was the ability to speak to the endoscopist immediately post-procedure. Patient rating of pain was not significantly different between the sedated and unsedated groups. There was no significant difference in the independent assessment by the endoscopist and the nurse with respect to patient comfort in both the sedated and the unsedated groups. However, their assessment differed significantly from the patients own rating, as endoscopists and gastrointestinal (GI) nurses rated the patient degree of comfort as higher than the patients themselves (P< 0.01 for doctor/patient and nurse/patient score, Student's t-test). No complications were reported in either group of patients during the audit. Unsedated diagnostic gastroscopy is perceived to be an acceptable alternative to a sedated procedure by the majority of patients. Patients rate the procedure as more uncomfortable than their health care professionals, but the majority of patients would still have the repeat procedure the same way.

Another article describing unsedated colonoscopy found here:

http://findarticles.com/p/articles/mi_m0BJI/is_3_31/ai_71632710 says

Colonoscopy without sedation should be considered the new standard approach to the procedure, Dr. Joseph G. White maintained at the annual meeting of the American College of Gastroenterology.

The success rate is high, and most patients accept--even prefer--not being sedated. Eliminating sedation also speeds up the procedure and saves money by reducing recovery room time. It also spares patients the risks associated with sedation, said Dr. White of the Scott & White Clinic, Temple, Tex.

I have also obtained Versed product info from American Pharmaceutical Partners, Inc. It states in the section titled "Information for Patients' that "patients should be informed of the pharmacological effects of midazolam, such as sedation and amnesia, which in some patients may be profound."

I have requested a copy of my patient consent form from the place where i had my procedures performed. I have not received them at this time but am quite sure I was not informed of the potential for amnesia.

At this point I am very interested in knowing why I was not informed that the unsedated procedure was an option. I almost believe that sedation is used since they can charge more for the procedure - and most patients don't care because it is just being billed to an insurance company.

Finally, I want to also mention that while my memory of the procedure was limited, I do recall crying out in pain during the colonoscopy. This really bothers me since I know they did give me any pain medication during the procedure. I feel as if i had been chemically handcuffed by the Versed in lieu of appropriate pain medication and/or the procedure was done in a manner that they would not have done if they knew I was fully aware.

Damn I am still so angry about this. Thanks for having this blog and letting me vent my feelings.

John

Jackie said...

I check back with this site frequently as Tim has become a cyber friend. To all of you who have had this experience with the Versed, isn't it ODD that we all can describe the same exact mental reactions to this chemical? As I read the posts of others and re read my own I can see a pattern in the disruption of our mental processes. Anger, anxiety and obsession are at the top of the list, which is really bad for those of us who previously could be described as normal. It is disconcerting to suddenly have mental problems. For John, I never signed an informed consent, just the general consent to treat. ( in violation of Federal law!) What I was telling the staff I found acceptable was so completely opposed to what THEY wanted that they decided just to go ahead without my informed consent, (which I would NEVER HAVE GIVEN) thinking that I was too stupid to notice. Since I am "just a truck driver" and they are trained medical professionals, they "know what's best" for me. They don't tell me how to drive my truck and I can't tell them what they can or cannot do to my person. Every single one of them to a man used this argument on me! Federal law states that we must not only be informed of the medications and effects of such, but that we may decline to proceed with the operation AT ANY TIME, even after beginning. By injecting patients with Versed these people are in effect removing our right to refuse further medical treatment. Clever isn't it? Some nice amnesia to boot and they can and do claim that they had your complete consent, you just don't remember giving it! It is my belief that the medical professionals look at Versed as a double whammy. They can not only charge about 4 times as much, but they get the added benefit of an unconscious, compliant patient. I don't give a damn about the "conscious sedation" crap, you are unconscious. The phrase "psychotic fugue state" is a more appropriate phrase. Now I have to live with several mental disorders, just because some sanctimonious, self righteous, self serving cretins in a hospital attacked me with Versed! Erica, I went through my documents from a dentist that worked on my baby when whe was 2 and found out to my horror that they gave my innocent child this evil drug. I am having trouble coming to grips with this atrocity as well. I think to myself "what kind of mother would let their child be assaulted with this kind of drug?" I can't get it out of my mind that I allowed this to happen to my child. Please let us know how the Doctor appt. went. I am very interested if the drug damaged your brain. John's post shows that his wife had brain damage. Since all of us have the same symptoms, I would guess that we all have had some damage done to a specific part of the brain.

Casey said...

THANK YOU! THANK YOU! THANK YOU! I am so relieved to find I am not the only one out there angered by the medical community. I am the spouse of a colonoscopy patient that was given Versed(no choice). He had a good experience, BUT was not informed of the amnesiac affects(just something to relax you) and, in fact, cannot be certain they even did anything!!! We, too, were misled, mis-imformed, given half-truths, and outright lied to. WHY,WHY, WHY do they not fully inform? We have come to the conclusion, as have many of you, that it is solely for the staff's benefit and "follow the money"!!! We have learned much through all this: RESEARCH. BE FULLY INFORMED. DO NOT BE INTIMIDATED. ASK, ASK, ASK UNTIL YOU GET THE ANSWERS YOU NEED AND DESERVE. INSIST ON COMPLETE DISCLOSURE. DON'T BE PUT OFF. TAKE NOTES TO INCLUDE DATE, TIME AND ESPECIALLY NAME. IF AT ALL POSSIBLE, TAKE SOMEONE WITH YOU THROUGHOUT PROCEDURE(we were denied this request)TO PROTECT YOU. Further information and links to more information would be greatly appreciated.

-Tim said...

Casey said...

"THANK YOU! THANK YOU! THANK YOU! I am so relieved to find I am not the only one out there angered by the medical community. "

Welcome to my blog, Casey! You're welcome!

"I am the spouse of a colonoscopy patient that was given Versed(no choice). He had a good experience, BUT was not informed of the amnesiac affects(just something to relax you) . . .We, too, were misled, mis-imformed, given half-truths, and outright lied to. WHY,WHY, WHY do they not fully inform? We have come to the conclusion, as have many of you, that it is solely for the staff's benefit and "follow the money"!!!"

This is exactly the same page my wife and I are on (I had hernia repair). Welcome to the club!

"Further information and links to more information would be greatly appreciated."

Well, here is my latest collection of links:

http://www.askapatient.com/
viewrating.asp?drug=18654&name=VERSED

http://ideas.4brad.com/archives/
000100.html

http://www.medicalnewstoday.com/
youropinions.php?opinionid=11517

http://www.colonoscopywarning.com/
colonoscopy/beware-the-colonoscopy/

http://www.netwellness.org/
question.cfm/43700.htm

http://www.redorbit.com/news/
health/631560/prevent_drug_disasters/
index.html?source=r_health'

http://allnurses.com/forums/
f16/ethical-legal-question-54987.html

Anonymous said...

a follow-up to my earlier post: i received my patient records today and see that i was given 150 mcg of fentanyl prior to the procedure along with 3 mg of versed. Twenty minutes later (at the time when i was crying out in pain i presume) I was given another 1 mg of versed. Why did they respond to my pain by giving me more of a drug that does not affect pain - only my recall?

In the nurses notes it indicates that the procedures were 'well tolerated'. Really? Not in my opinionn since the only recall I have is one of being in distress.

Additionally, the report indicates I was given an IV with 1 mg of versed throughout the procedure. And although the procedure was finished at 1304, the IV was not discontinued for another 26 minutes. Why the continued medication?

Finally, with respect to patient consent, the only records they have is a note that says "pre op instructions given". Never was the word "amnesia" ever mentioned. Why?

I find all this troubling. Not a lot to do at this point but I hope others are forwarned.

John

Jackie said...
This comment has been removed by a blog administrator.
Anonymous said...

Jackie,

In requesting information from the facility about my procedure and the medication I was given, I specifically requested any consent forms I may have signed. None was provided to me. I did not recall ever seeing or signing one but was thinking with all the things they typically ask you to sign (insurance, privacy, etc.) maybe I signed one without noticing it. But it appears there was not one provided and/or signed in my case.

John

Anonymous said...

John if I may suggest talking to a bunch of lawyers until one takes your case. No "informed consent" equals an assault in some states. I had to call at least 10 and I e-mailed 10 more before I found one. I didn't get anywhere until I could prove that there was no "informed consent."

Antigone said...

On the issue of Versed, I think even under "informed consent" one could argue that the term is ambiguous. If a patient signs an informed consent to mild sedation, and the physician suggests as does the literature distributed that the patient may experience slight abdominal cramping, with no pain or discomfort, and probably won't remember, then really, is that informed consent? The term is ambiguous, a fact that could be argued in a court of law. I am all for a suit against the drug manufacturer. I had a horrific experience with this drug during my colonoscopy, and was in excruciating pain and still have nightmares about it. I did contact my practitioner immediately and they are changing their policies to better educate patients, which I think is fair. Still, I think use of this drug is questionable and dangerous at best, as it seems completely unpredictable

Jackie said...

Any Versed sufferer out there from Greenville SC? If so I need to talk to you...

Anonymous said...

My wife had a colonoscopy two months ago. They told her nothing, just "sign on dotted line" and "you will not remember anything"! They used versed, 3 mg followed by another 5 mg during the procedure. She came out of this with everything described as I have read here. All I want is my wife back as she was before the procedure. She was a strong woman, and now she is a basket case. She refuses to go to any doctor now and she does have problems. She is afraid she will be tortured more. The lawyers just laugh, say it will cost to much and we will lose. Just why is this allowed in the United States? How do we stop these butchers!

-Tim said...

I would suggest that it is allowed by the powers that be because of money, convenience, and probably people taking the path of least resistance.

How to stop it? We need a few lawyers. I'm waiting for the Versed pushers to piss off a lawyer - when one feels the way we do here, he/she will probably want to join the club.

Until then, I would encourage folks to meet here, to share their ideas.

Post an email address for us to use, or, if you'd like me to keep it private, send me an email at tolena2001@yahoo.com.

Anonymous said...

Believe it or not, they don't give this stuff to lawyers when they go in for a procedure. Wonder why! At least that is what the nurse told me. They only get the demerol. So I doubt one will get pissed off.

My wife and I have done something but don't know if it will do any good. We took out a reader ad in the local penny saver directing people to the "www.colonoscopywarning.com" site. Hopefully it will get some people asking questions.

Jackie said...

Dear anonymous, I am a strong woman and Versed reduced me to a paranoid maniac as well. I can tell you this. The first 2 months were the absolute worst. I was so freaked out I could barely hold a coherant thought, couldn't perform my job, couldn't sleep and wanted to kill myself and others. The mania has slowly subsided. It is almost a year now and while I am still FURIOUS, I don't feel so out of control. I still have problems sleeping and concentrating, but not ANYTHING like before. Kirt told me that his whatever the Versed thing is peaked after some weeks and THAT information kept me from going completely insane, thinking that I would be that way forever. Whether we get over it completely or not remains to be seen. I am also too anxious about Versed to go back to the hospital. I have a medical alert bracelet that says "no Versed," but I still don't feel safe. I need another surgery to correct the dangerous outcome of the first one, and I wrote Tim last week telling him that I am just too terrified to go back into the hospital. And believe me I am pretty tough! These people are absolutely determined to use this substance on us and I have been unable to get anyone to confess truthfully why they desperately want to use Versed. There IS a reason why. We in the general public just don't know what that subversive reason might be. The medical staff has seen many many people have a seriously bad reaction to this particular drug and yet they use it. By the way, I wrote letters to the editor outlining the abuse of the drug Versed and got some sympathetic replies and a LOT of very vitriolic people trying to justify using Versed by calling me names, impugning my motives for telling about Versed (fearmongering) and opining that I must have the "IQ of a gnat" or been "crazy" all along. Don't let that upset you. This is an extremely bad drug and the more people know about it the better off everybody will be. Here is an odd thing about Versed. It appears (anecdotally) to affect analytical minds the worst. There are way too many engineers and professional people with adverse reactions to Versed, as opposed to the nebulous "other people." You know, all those happy people who love having their brains melted and approve of chemically induced mental illness.

John said...

Jackie,

"Way to many engineers and professional people..." That's an interesting observation, since i'm an engineer also.

I saw a therapist last week about the anxiety and anger caused by my negative Versed experience. One of the things we discussed was my total lack of recreational drug use (except for alcohol). He seemed to feel this was significant. He feels alcohol is not the same as other recreational drugs in that one is typically more aware of and able to calibrate the effects. He says people vary significantly in their willingness to 'loose control' via drugs. I think he is correct in that this is related to my feelings about my Versed experience. I probably desire it less than most people, hence my strong reaction to having it done to me without my knowledge or consent.

I am happy to note that my out-of-control anger and anxiety are greatly diminished after this single visit to the therapist. We initially got off to a rocky start since he requested I sign a 'consent to treat' form that had blank spaces on it, so we had to have a little discussion about that issue first, cause I'm not casually signing any forms like that again (not that i was even offered the opportunity to sign one for my Versed experience). In any case, I now feel i'm in a position to regain control of my feelings about this whole thing. I recommend anyone with these problems seek similar mental health counseling. It certainly has been helpful to me.

I commend Tim for starting this site and giving people a forum to express their feelings and maybe somehow warn unsuspecting people before it happens to them. But I also hope that people that have been harmed by this drug find whatever method works for them to be healed and go back to having a good life. Personally, I find the mythical story of The Drowning Man Ritual to be particularly helpful in convincing me to forgive (even to those who might not deserve it) and free myself from the terrible psychic burden of anger. I think there is great value in forgiving those who we believe have harmed us - not for their sake, but for our own. As a fellow Versed victim, I have empathy for your anger and know you deserve to be relieved of the harmful emotions you continue to experience.

John

The Drowning Man Ritual
Everyone who loses somebody wants revenge, on God if they can't find anyone else. But in Africa, in Matobo, the Ku believe that the only way to end grief is to save a life. If someone is murdered, a year of mourning ends with a ritual that we call the Drowning Man Trial. There's an all-night party beside a river. At dawn, the killer is put in a boat. He's taken out on the water and he's dropped. He's bound so that he can't swim. The family of the dead then has to choose. They can let him drown or they can save him. The Ku believe that if the family lets the killer drown, they'll have justice but spend the rest of their lives in mourning. But if they save him, if they admit that life isn't always just... that very act can take away their sorrow.

-Tim said...

There is a thread in the All Nurses forum that was quickly shut down when the docs didn't like the responses they were getting:

http://allnurses.com/forums/f16/ethical-legal-question
-54987-7.html#post2116811

An engineer (ORNLxxx) gets to the heart of the matter:

ORNLxxx:

Re: Ethical/Legal question

"I am a patient and although I haven't read this thread entirely I would like to make a comment. I too feel that my right to informed consent was compromised. I was
given Versed without any discussion of how it would erase my memory for the next 2 hours. Had I known this I would have asked what other options existed (i.e.,Valium), and whether anything was necessary as I was not experiencing anxiety. Yes, I understand that Versed
acts in an additive way with other anesthetic drugs. However, can anesthesia really not be performed without Versed ? I doubt it.

As for how much I want to know -i.e., "need to learn anesthesia from a non-anesthesia professional". Well, I think I should have been given options, i.e., would I rather have an anesthetic that guarantees I will be out of commission for several hours but also if there is a problem can be reversed pharmacologically, or would I rather have an anesthetic that has a much faster half life but cannot be reversed (i.e., propofol). I would have chosen safety over a couple of hours of inconvenience.

I recognize my limits in terms of knowledge about anesthetic drugs and defer to the experts to give me the facts. However, I, and I alone, have the right to make decisions about my treatment. I am an engineer. Give me the complication rates, give me your recommendations, and then let ME make the decisions.

From what I know now - Versed will not be in my future. I don't know about propofol but I do know that whatever drugs that have the absolute least likelihood of killing me will be my choice. I don't give a crap whether it is convenient or whether my caregiver prefers that I not
remember."

paindoc:

"What more needs to be said on this subject that hasn't already been said. This is endless repetition of the same contentions and assertions. There can be no useful discussion on this issue due to a matter of perspective."

traumaRUs:

"This thread was started in 2004 and began with a theoretical scenario. It has rambled along for 7 full pages and is now focused on individual patient experiences which borders on providing medical advice. We at All Nurses can not provide anesthesia advice anymore than we can provide medical advice. I understand your concerns about medications given to you. However, I would advise you all to bring your concerns to the your anesthesiologists of choice and proceed on.

If you feel something has been done against your will, please again bring it up to your medical provider. Take care..."
-------------------------------------------------------------------------------

Paindoc refers to "perspective" which is ludicrous since the main thread here is anesthesiologists blatantly walking over patients. Saying "no" to Versed is unambiguous.

TraumaRUs calls attention to the fact that the thread began in 2004. So what? Also, the "theoretical" scenario referred to was most likely an actual event. Finally, it is a stretch to say that the posts are bordering on medical advice.

What weak excuses! They ended the dialog because they did not like the tone of the responses.

-Tim said...

Here's another place to complain:

http://www.jointcommission.org
/GeneralPublic/Complaint/

Casey said...

I've been trying for a loooong time to get someone in the medical community to talk to me about Versed. Anyone have detailed step-by-step information on exactly how Versed acts on you? How exactly it affects the patient? What an observer would see? How the patient feels?

-Tim said...

Casey:

I do not know the exact mechanisms involved, but it is suppsed to sedate a person and it generally causes amnesia. People can, apparently, carry on a conversation while under the influence. An observer may notice little if anything. One problem is it often turns people into zombies - they are more or less paralyzed and may lose touch with where they are.
If you read the stories here and on askapatient.com, you will find people who recall being aware but were unable to control their body and unable to communicate. Many experienced pain. (Versed is not supposed to kill pain).

Dot said...

I've had a few experiences with Versed, and just let me say, I have a Medic Alert necklace that says that I am allergic to benzodiazepines. Any surgery that I have in the future will be with general anesthesia and not before telling everyone that I come in contact with at the hospital that I "WILL NOT TAKE VERSED."

I have a colonoscopy every 2 years without anesthesia (just some demerol) and, while a little painful, absolutely the right choice for me.

My problems with Versed were the after-effects (but then, of course, I don't remember anything about during the procedures). I experienced extreme insomnia that lasted months, blunted emotions, an inability to be still, and large hives that appeared off and on for months. I had other symptoms, but I'm not sure if they were caused by the Versed or by the fact that I couldn't sleep, etc.

This happened to me a couple of times, but the last time was when I put the puzzle together. I thought I was just going crazy, but found a group on the web that pretty much saved me. I took me almost 2 years to feel like things were back to normal again.

I'm glad to find this blog, and that it's available for others to access before they innocently agree to administration of Versed.

I have to say that I have relatives who have used Versed with no problems, but for me, never again.

L said...

I was first given Versed in 2005, when I went to have a colonoscopy. Prior to that, I had never even heard of the drug. Before the colonoscopy, I was told by my internist that I would be “knocked out.” The lady who scheduled my appointment with the gastroenterologist told me that I would have a “twilight drug”, that I would have a “conscious sedation.” No mention was ever made by any medical personnel about anterograde amnesia. After the colonoscopy I had a very strange, creepy feeling for several weeks. I felt as if I was trying desperately to remember something but couldn’t; like I was trying to remember someone’s name. I wondered what kind of drug I had received for the colonoscopy because I was so obsessive about it. I got a copy of my report from the gastro.’s office and found out that they had given me Versed (Midazolam) and Fentenyl (a very strong pain killer). I researched Versed and found out about the amnesia. That’s when my weird feelings finally started to make sense to me.

I felt that I had been deceived and violated. I had thought prior to the colonoscopy that I would be receiving a drug that would just make me relaxed and not care about what was happening. I was disappointed afterwards to not have any recollection at all. In 1978 I had general anesthesia for surgery but it was not the same. Gen. anesthesia did not give me the weird, creepy feeling that Versed did. I felt that I did not want to ever receive Versed again.

Months later, I had to have surgery and knew that I would be receiving gen. anesthesia so I didn’t even think about Versed. After the surgery, I had the same weird, obsessive feelings that I’d had after the colonoscopy. I became extremely depressed and anxious. I ended up having to see a psychiatrist who put me on antidepressants. Later, I got a copy of my surgery report and found out that I had once again received Versed. Apparently, Versed is now used prior to general anesthesia being administered.

I had no idea that they would give me Versed before general anesthesia or I would have requested that they did not give it to me.

Now I am anxious about receiving Versed again without my consent or knowledge.

For a long time I thought that I was very unique in my aversion to Versed. Other people who I talked to who’d had a colonoscopy had not had the same creepy feelings that I had. Other people wondered why I would want to remember anything. Then I found some other people on the internet who shared my animosity toward this drug.

I think that the FDA needs to do more research on the adverse effects of Versed. It’s only been around since 1986 and was initially used in pediatrics to alleviated separation anxiety in children when they had to be away from their parents. It gave them amnesia so that they wouldn’t remember from one moment to the next that their parents weren’t there.

Now it is used on thousands of unsuspecting people every day for dental surgery, in ambulances, and for endoscopy procedures. A friend of mine had in vitro fertilization at an infertility clinic and they used it on her there. She said that she didn’t care because she didn’t want to remember anything about it.

I don’t know why Versed bothers some people and other people it doesn’t. All I know is that it frightens me.

Anonymous said...

Jackie and Tim,
Thank you so much. Finally have my wife back!!! She finally got the help she needed. She is seeing a therapist and a psychiatric nurse practioner. It took a while for them to gain her trust and find a medicine to bring her out of the depression. It took at least two months to get her to that point. They started her out on real low doses of the meds, but it kicked in the next day! On her second appointment with the nurse practioner, she went right up and hugged him and thanked him for giving her a life again.

It was a real bumpy road for a while, but you guys carried us thru it. Now we have to find her a medical doctor who we can trust. Not going to be easy around here! Where we live, the doctors and hospitals make the hospitals in Erie and Pittsburg, Pa look like heaven!

Again, thank you!
Pat

Jackie said...

I want to point out a problem with Versed administrators that we all need to be aware of. At www.allnurses.com I became embroiled in a debate over the abuse of Versed. Apparently you, as a stupid patient are not to be allowed to contradict what the DOCTORS want to give you. If you try to "tell them their job" they will administer Versed out of spite. If you nicely ask them not to give you the drug, they will give it to you anyway, because they "know what's best." If you vehemently refuse this little poison, they will refuse to treat you.

flagdaygirl said...

I just wish I knew how to find a doctor who will do a colonoscopy without versed. I have called them all. Most refuse to let me speak with a nurse or doctor on the phone "unless you are scheduled for a colonoscopy with us." I sure don't have time to make appointments all over town only to cancel the procedure after the consultation!
Anybody in the Raleigh, NC area have one without versed? I don't mind a little sedation, but I want to REMEMBER EVERYTHING that happens to me.

Anonymous said...

I am an anesthesiologist at a large training institution. It is standard of care to administer anxiolytic/amnestic agents to patients prior to surgery. While I would agree that nothing should be forced on a patient or given to them without disclosure, I also believe that the positives of a small amount of memory loss prior to induction of anesthesia is a beneficial thing, especially when compared with the spector of awareness under anesthesia, which is far more frightening to the anesthesiologist, both from a patient care perspective and from a medicolegal one.

With that said if you were to refuse versed, and I believed that you understood the consequences (i.e. you might remember: being induced, losing your ability to breath spontaneusly, having the nurses shave/scrub/clean/undress areas of your body), then I would have no problem withholding this medication.

It seems as though people who are upset that they received versed are those people that feel that they coud be embarrassed by conversations they had or hate not knowing everything that went on during their pre-operative/operative minutes. As an anesthesiologist, it is my duty to guide you through surgery with as little trauma (physical and psychological) as possible. My colleagues and I take this very seriously. We believe that for most every case, preoperative versed is a very valuable medicine, in that it relaxes a patient, helps prevent wild blood pressure and heart rate change when preparing for surgery, and causes mild anterograde amnesia. It is a remarkable safe drug in the doses given for this reason.

If the complaints are a result of an underlying distrust of your physician or a dissatisfaction with the outcome of the procedure, thats certainly another issue. However, if your procedure went well, and you woke up without remembering: being intubated, being incised, being stitched up, having organs manipulated, etc. then it served its purpose.

Realize also that you have a say in your medical care up to a point. If you elect to have a procedure, and elect to be anesthetized, there are only so many things you can dictate regarding the procedure and the anesthestics administered. We have a job to do, and we need to do it safely...your anesthesiologist should ALWAYS tell you the medications he/she is administering, however, and should always tell you what they do.

Jackie said...

I am absolutely STUNNED at the deliberate evasions of the esteemed Doctor. I wonder if he bothered to actually read the posts here. Doctor, we are all suffering from a drug induced mental illness brought on by Versed. Our symptoms are nearly IDENTICAL sir! We are young and old, male and female and while we haven't seen fit to discuss race, I am sure that this drug reaction cuts across racial lines as well. This Versed, which you give out without regard for the consequences that we patients face, is a very bad and volitile drug which has long term reactions in a large sub set of patients. Your incredible disregard for what this drug has done to us is unconscionable, and you are at a teaching hospital! FYI I did specifically refuse general anesthesia AND I chose to be awake and alert! I WANT TO KNOW WHAT HAPPENS TO ME! I don't want to wake up, strapped to a bed, and find that I now have a botched operation, a kidney infection from a catheter, and some kind of mental illness from the Versed! Why is this so hard to understand? Give me the awareness please! That is the whole point. We want to be aware! We don't want or like the sneaky injection of this amnesia producing drug. We don't want to have to go for "therapy" and take ever more drugs just in order to return to our previous mental state! You are arrogant sir. To say that most of us need Versed in able to handle discomfort is assinine at best, self serving at worst. It is just this sort of cruel punishment that you anesthesiologists have devised for us by using the drug Versed that made me seek an attorney! I would rather have had aspirin and the proverbial bullet to bite than the Versed and a general anesthetic. I would rather have been treated with respect and dignity than have the OR staff making rude comments about me while I was under the influence of Versed. (NO the amnesia did not work as planned) I would rather have taken my broken arm and gone home than experience the total lack of regard for me and my body by my sadistic caregivers. I wish I knew where you were practicing so that I could make sure to avoid you, but as usual you guys hide behind anonymity. If you are so proud of your "care" you would give your name wouldn't you?. One last point. Are you going to have Versed when you have an operation? If you say yes, you are a bigger liar than I understand that you are.

Jackie said...

I have re read the sanctimonious post by the "Doctor" and have a couple of more points that I want to make. Obviously when you speak about medicolegal problems and anesthesia awareness, you are concerned only for yourself and not for the patient. It's called Cover Your Ass in current vernacular. Don't try to sell that as something for the patient. Versed does not cause relaxation, take it from a patient who has been assaulted with this drug. A flaccid body and/or amnesia should not be construed as "relaxing," it is NOT! I am also very alarmed about your statement about "mild anterograde amnesia." Define MILD as it pertains to the amnesia can you Doctor? Isn't it like being pregnant? You are or you aren't? It is total amnesia isn't it? What is this mild Crap? Do you think having my willpower stolen from me and cooperating as the surgical staff went ahead with their desired general anesthetic against my will was relaxing? Being so incapacitated that I couldn't resist their ministrations was good for my mental health? This has to be a joke.

Anonymous said...

So, I value the opinions and feelings of my patients. I tell my patients what medications they will receive and listen to objections and will not administer a medication that a patient does not wish to have (as I stated). I understand that not all physicians behave this way.

Drugs can definitely affect different people in different ways. I value all the feelings expressed by the posters here, and I simply wanted to provide another source of information, since this medication is almost universally administered in my field. Its definitely important for practitioners to know the type of potential problems with it.

As far as the "cover your ass" medicine that was alluded to, several posters have mentioned attorneys and lawsuits, which are definitely provocative subjects. However, I believe that patients should retain their legal rights in situations such as these, and would never want to take away someone's right to seek legal recourse in this case. I prefer to believe that my practice of medicine and the well thought-out standards of care amount to more than "cover my ass" medicine. Since we have never met and I have likely never adminstered an anesthetic to you, perhaps we can just agree to disagree.

Above all, the physicians that I know, would never want to harm a patient or create PTSD or other long term complications. This is an awful possibility and really weighs into many of our decisions. But I can only speak for myself and the people I know well.

I wish all of you the best and I hope that you can find some redemption and doctors in the future who will treat you with fairness and openness.

Kirt said...

To the anesthesiologist at the 'large training institution:' I suspect much of what you said may be a response to some of my original complaints. I have no doubt that you most of your colleagues are sincere and really mean well. I am glad to see you did underscore the importance of telling the patient what is being done. You also rightly pointed out that the patient ultimately should have a choice. Had the former been done in my case I don't think I would have a complaint. I suppose my wrath toward Versed has much more to do with how easy it made it for the doctor that worked on me to not tell me anything.

I freely admit that I don't like anesthesia because I don't like not knowing what is being done to me - that is just how I am and I make no apologies for it - The same trait helps make me a damm good engineer. However I also am reasonable enough to know that not every procedure can be done under local anesthesia (I hope that day comes) and I did agree to being put uner for my hernia repair.

I would like to echo what Jackie said - what is the 'small amount' of memory loss you refer to? I remember nothing after arriving in the operating room. Should I? Was I overdosed?

Lastly I feel that there are enough people on this blog who have had bad experiences (much worse than I) with Versed, that I think someone 'in the know' should be at least be taking them seriously. I would love to see a reasoned response to some of the specific complaints they describe.

kirt said...

To the anesthesiologist: I guess our previous posts crossed timeswise.

I think your responses have made me feel somewhat better. After my surgery I called my anesthesiologist and chewed him out (to put it mildly) for not having told me what he was about to do. The conversation was the most unpleasant one I have ever had with a medical provider. He was extremly arrogant. I am glad to see that you seem to agree with me that his hidding of information was not good. I am not normally one to make much of a fuss, and I find that when I have to complain vehemnetly it really upsets me - and in this case I was already upset by the surgery.

I would urge you as a staff member at a teaching facility to remind your students continuously about the need for good communications with your patients.

Anonymous said...

As far as my experiences with 'mild anterograde amnesia', people typically forget the things that are being said to them as the medication is being pushed or very shortly thereafter (why I encourage kissing family members, etc PRIOR to this med being given). The amnesia typically lasts through surgery and usually only a few hours after.

While I understand the rationale behind the use of versed and the fear that patients will be more traumatized by experiencing surgery than by forgetting it, I do not excuse people for giving this med when explicitly refused by the patient.

-Tim said...

Response to some of the comments left by the Anonymous anesthesiologist:

Tim:
First, it is a relief to hear one of you say in plain language:

"...I do not excuse people for giving this med when explicitly refused by the patient."

Perhaps you would hazard a guess as to why so many are forceful or underhanded about giving this drug to their patients?

> "I am an anesthesiologist at a large training institution."

Tim:
It would be nice if you were not anonymous - a link to your practice, your personal web page, etc.

> "It is standard of care to administer anxiolytic/amnestic agents to patients prior to surgery."

Tim:
I have had plenty of surgery before my last one and never had versed. I don't know why anyone would ever consider amnesia a good thing and I am frankly stunned that it ever occurred to anyone.

> "the spector [sic] of awareness under anesthesia, which is far more frightening to the anesthesiologist, both from a patient care perspective and from a medicolegal one."

Tim:
I have read of this awareness, and it seems to me that as either a patient or a doctor, I would want the patient to remember so they could report it. Is this not useful information?

Your reference to "medicolegal" is alarming, since an honest person would not give you amnesia if there was nothing to hide. If someone said "oops" I would definitely want to remember that.

> "With that said if you were to refuse versed, and I believed that you understood the consequences (i.e. you might remember: being induced, losing your ability to breath spontaneously, having the nurses shave/scrub/clean/undress areas of your body), then I would have no problem withholding this medication."

Tim:
I have been through a number of things, including two hand surgeries that had the potential for excruciating pain. I chose local both times, made out fine. This was before Versed and I recall both experiences. The times I had general was never stressful, but I don't know how the dentist's office compares to other surgery. When I had my wisdom teeth removed (two separate sessions) I just went out like a light.

As far as the shave/scrub/clean/undress business goes, I am neither bothered by this nor would I consider using anxiolytic/amnestic drugs if it did bother me. It stuns me that anyone would consider this.

> "It seems as though people who are upset that they received versed are those people that feel that they could be embarrassed by conversations they had or hate not knowing everything that went on during their pre-operative/operative minutes."

Tim:
This is only the beginning. I was angry over being deliberately deceived. I had a bad reaction to this drug. I have deduced that I was in a sleep paralysis mode while having lost track of where I was. I am pretty sure I was freaked out. This has been reported by several people who were able to recall their experience.

It has been almost three years and I still have these odd flashbacks - there is an overwhelming feeling of trying to recall something but I just can't put my finger on it. This is accompanied by a very tense anxiety. It has a chemical or pharmacological feel to it also.

As another poster said, I resent having my brain and memory fooled with, regardless of how safe anyone else may think this drug is.

I could go on, but I will add one more item: there is clear evidence of residual memory. (There is a handshaking experiment that demonstrates this). see http://www.alphaomegaalpha.org/PDFs/Pharos
/Articles/2004Winter/HopeMDEverydayAmnesia.htm

> "As an anesthesiologist, it is my duty to guide you through surgery with as little trauma (physical and psychological) as possible. My colleagues and I take this very seriously. We believe that for most every case, preoperative versed is a very valuable medicine, in that it relaxes a patient, helps prevent wild blood pressure and heart rate change when preparing for surgery, and causes mild anterograde amnesia. It is a remarkable safe drug in the doses given for this reason."


Tim:
Obviously, in a large number of cases, versed causes people to freak out. I'll bet that if people did not get amnesia, you would have a lot more complaints. This is another thing that bothers me: if the drug causes amnesia, then how the hell do you know what people are really going through? I think using versed is a very dumb idea.

Anonymous said...

Just to continue. Versed is not an "oops" drug. We operate under an umbrella of total accountability and total openness. At my institution, you would find out if mistakes were made, because we would tell you. Versed is not used to cover up errors or ease the mind of those in the operating room so that the patient wouldnt remember what was said or done. The intention of this drug is to ease the psychological load ON THE PATIENT. A huge proportion of patients would rather not remember their surgery, and versed helps make this possible.

Apparently, from the comments herein, versed has the ability to cause psychological stress also, and this is something that we need to look into.

And again, my reference to "medicolegal" is only in response to the suggestions of lawsuits and litigation for the use of versed. In this day and age, having a patient become awake and remember being operated on is a much scarier consideration (for an anesthesiologist and for a large majority of patients) than the prospect of having a patient develop a negative reaction to versed, even though such things apparently exist. I would, however, not agree that there is a proportionately large number of patients who 'freak out' on versed, considering how many times per day it is given.

Please understand my choosing not to disclose the name of my institution, as I only wish to speak for myself on this issue.

-Tim said...

Well, that damn versed has caused me and a lot of other people ongoing "psychological load" for YEARS after the surgery. You claim that a huge proportion of patients would rather not remember their surgery, but I doubt that a majority of people have been polled. They certainly didn't poll me. My wife was with me during the pre-op consultation and we agree in retrospect that the jerk who worked on me had decided how she wanted to proceed and said whatever she had to to get around me.

Again, how do you KNOW who's having a bad experience under versed if most people have no recall? How can you make that assertion?

Jackie said...

Doctor, I am pleased that you did not turn tail and run from the vehemence of my reply. Everything about Versed, its stealthy administration, the odd effects of it even without the amnesia, the rude comments from the CRNA when he thought I had amnesia, the complete violation of my rights due to Versed, and the on-going psychological problems are almost to much to bear. I am going in on Tuesday to repair the damage done by the first surgery and I am absolutely panicked. Since Versed was called a "muscle relaxant" and I hear it referred to as "sedation" who knows what the medical people will pull next time? Amnesia is not described in any "sedation" description. Look up sedate in a dictionary. Since when does a muscle relaxant include a complete removal of will power? It is duplicitous wording like this that worries me. I know that the CRNA is wanting me to have a "sedative." How do I know that this will NOT include any of these other effects? THIS time I am very nervous about going in to the hospital, where I was NOT ANXIOUS PREVIOUSLY. I am not as concerned about the surgery which is dangerous enough, but the DRUGS that are going to be injected! There is a difference in my attitude however that I hope will be helpful to ME. I am not the nice pleasant woman who went in for the last surgery. I am a lot more demanding and very distrustful. I feel that the only way to prevent Versed use is to be aggressive about it. To be nasty if needed. I have explained that Versed is a deal breaker and that if they try to give it to me I will leave. I'd rather face the loss of use of my hand than one more injection of this poison. I am guardedly hopeful about the operation because the new medical team did not refuse to treat me under MY conditions. You people may want to rethink your "standard of care" if it involves smashing everybodys' brain with Versed. I can't figure out how this happened! This is the first I've heard of forcing all patients to endure the amnesia and personality destroying drug Versed!

Anonymous said...

versed has been administered hundreds of millions of times, likely to at least one out of every three or four people you know...and with all due respect, your results are atypical. that is not to imply that they are not real, however. we expect that medications will occasionally cause problems for a small portion of patients and we constantly work on ways to predict/prevent this. this is a fine medication that helps many people through surgery. i am truly sorry that it did not help those of you who frequent this board, or rather, that it has instead hurt you.

i encourage you all to be thorough and diligent, and tell your doctors specifically what you do not want. they will have no choice but to comply, especially with a controlled substance whose administration must be documented.

Anonymous said...

To the anesthesiologist: I explicidly told my Urologist I absolutely did not want any medication that would affect my memory of the ESW Lithotripsy procedure. I was deceitfully given Versed anyway and my mind is a total blank from the moment of administration to a few hours later in the recovery room. Now I don't trust medical personal and will refuse to be treated at all rather than go through this experience again. I'm so adverse to repeating this I'll forego treatment and end up dead when the outcome otherwise could have been another life saved - so put that in your 'patient care' pipe and smoke it

-Tim said...

Tim responding to the anesthesiologist's post of 13/6/07 21:59:

I appreciate that you have stayed in the ring so far and, to borrow your phrase, with all due respect, you seem to be dodging some bullets here.

I think this is my third attempt, so here goes: How the hell do you KNOW what has happened after these "hundreds of millions of times" when, after the vast majority of them, the patient has amnesia? If I were a practitioner, I could not in good conscience - and would not - use such a drug just for this reason.

There are many episodes where the patient reports losing touch with reality and being really scared. I believe this is going on all the time, but most people don't remember it. This is not right!
I think this is what happened to me.

You have not addressed the fact that very often the docs are deceitful and forceful about using Versed. It amazes me that, right on the heels of your last post, a patient immediately replies that they were given this stuff against their wishes. I'll bet that this also has happened "millions of times".

I agree with this same poster that I now have a greatly increased distrust of medical people in general and I will be avoiding you folks in the future as much as I can. I honestly would rather get "Home Surgery for Dummies" and take my chances in my basement with some friends.

Jackie said...

Dear Doctor, I must beg to differ on some more of your points. I specifically declined any drug which would incapacitate me and also declined the GA over and over and over. No record was kept of me declining these drugs, just a record of what all THEY said to try to convince me. My surgeon, the CRNA, the anesthesiologist and the OR nurses all knew good and well that their desired course of treatment was in direct opposition of my wishes. And they went ahead anyway. I would love to go on, but I don't want to identify myself and this outrageous assault too much. Please believe me that the treatment you describe and the records that YOU allege happen in your hospital are poles apart from the treatment I recieved and which is defended by my caretakers as "knowing what's best," among other insulting statements.

Anonymous said...

So, I cant argue with you all about your experiences with versed or your complications after receiving the medication. I can attest to the many people we treat daily who have exactly the opposite result. Versed has been administered billions of times, and the fraction of people who have experienced the kind of problems that have affected each of you is VERY small, and you just have to trust me on that, since I see patients daily who have had surgery before and who have had versed before. I have only rarely had someone report having had a problem with it. Ive had people report that it does not work for them, and Ive had people who I have chosen not to give it to, after discussion with them.

I think the problem lies more in the care received rather than in the medicine itself. If you feel that you were mistreated, administered a medication that you specifically refused or had a bad experience with your anesthesiologist or procedure, then you are more likely to be angry and upset and then have problems with future anesthetics, to the point where you will not even seek out surgery. This is just as important a complication than one specifically attributable to a drug, per se. I also realize that we dont know everything there is to know about the sedative/hypnotics (of which versed is a member), but they are also some of the most widely used medications in the world, and if the complication rate was as high as those on here believe, it would seem that there would likely be many more than 30 unique posters on this blog.

With that said, if you have been upfront with your doctor and specifically refused a medication or method of treatment, they shouldnt give it to you, plain and simple. This, to me, is the most alarming thing described herein.

As far as "Tim" goes: you are arguing that a patient could have a bad experience, but not remember it...where is the problem with that? If you are suggesting that there could have been mistakes made that would affect the outcome, that is one thing, but many institutions have an "upfront" policy, where all "mistakes/problems" are freely disclosed, so there is nothing to worry about there. Are people just upset because they wanted to experience, say, an ESWL procedure...which seems like it would be mind-numbingly uncomfortable. Is experiencing and remembering something uncomfortable that important to you? You all seem to suggest that we, as a community, do not take patient care seriously, but the whole goal of versed is to spare the patient any trauma they might have from remembering something painful or uncomfortable. Considering it does its job very well a large percentage of the time (try 99+%)

So, to you all, have surgery if you need it. Certainly dont threaten to die before having surgery again, as what would that do to your memory...permanent amnesia. Change doctors, go to a different institution, demand in writing "no versed" and be upfront with people. This is the only way we know what to do. Since we ask what medications people have allergy or intolerance to, you had better believe if "versed" comes up, you wont get it from me, just as if it were "penicillin" or "codeine"

-Tim said...

Dear Anonymous:

First of all, since you are so adamant, I will trust that you are one of the honest practitioners who actually takes their patients seriously, so there's no need to keep beating that drum.

You have yet to address the amnesia part, specifically, how do we know (for example) whether or not people experience the sleep paralysis nightmare that was described on askapatient (and I am near certain happened to me) ?

This also partly addresses your math ("it would seem that there would likely be many more than 30 unique posters on this blog.") How do you KNOW who is having a bad experience?

I'll bet you that if we could restore everyone's memory, then this blog would be overflowing.

You also said:

"With that said, if you have been upfront with your doctor and specifically refused a medication or method of treatment, they shouldnt give it to you, plain and simple. This, to me, is the most alarming thing described herein."

Of course I agree it is alarming. The more I probe this Versed business, the more people come forward with stories of having been duped into having Versed.

Again, do you have any theories as to why there is such a zeal to use Versed, and to outright lie to people about it?

You said:

" As far as "Tim" goes: you are arguing that a patient could have a bad experience, but not remember it...where is the problem with that?"

Because they should not have a bad experience in the first place (as you know, versed is not a pain reliever)
and because I simply do not want my memory messed with EVER, under any circumstances. I don't care how bad an experience is, I want my memory intact.

That's just for starters.

Who the hell are you, or anyone else, to make that desicion for me?

How about ongoing, residual effects? I continue to have memory issues, and it is going on three years now.

Also, I just don't understand why anyone would ever think drug induced amnesia is ever a good thing. Why would anyone ever invent such a thing?

You said:

"If you are suggesting that there could have been mistakes made that would affect the outcome, that is one thing, but many institutions have an "upfront" policy, where all "mistakes/problems" are freely disclosed, so there is nothing to worry about there."

"Many" is not good enough. Too bad you can't say "all".

And frankly, why should I trust strangers anyway? (Just curious, what color is the sky on your planet?)

You said:

" Is experiencing and remembering something uncomfortable that important to you?"

Having my memory intact is important to me.
And I resent being second-guessed.

More:

"You all seem to suggest that we, as a community, do not take patient care seriously . . ."

That is absolutey 110% correct.

" but the whole goal of versed is to spare the patient any trauma they might have from remembering something painful or uncomfortable. "

Maybe for YOU this is true, but the obvious zeal to impose Versed on people belies this statement. Something is very rotten here.
Having a hole in my memory is "painful or uncomfortable."
Nice of them to have considered that before
manipulating me into having Versed.

" So, to you all, have surgery if you need it. "

I'll think about that. But you can thank your colleagues who worked on me (and others here) for creating a deep distrust of your profession. I have every intention of avoiding medical people from now on as much as I can stand.

While I appreciate your final suggestions, there have been too many stories of people getting Versed even after they refused it.

Sorry doc, I just don't trust you people any more. If you're as honest as you say, then maybe you should poke around your industry and try to undo the damage these folks are causing.

Jackie said...

Hi Doctor! Since you are still with us I have some questions I am having a hard time getting the medical community to answer. Why do YOU want to give Versed, precisely? Not the gobbledygook (sp) that most will spout about how wonderful it is for the patient. Why do YOU want to give it? Do you think that AMNESIA should be an operative word for people considering Versed? I was in the OR last week and heard the nurse say that they were going to give this poor man "something to make you forgetful" and "you are going off to La La land now." The black hole is not la la land, nor is Versed going to make you forgetful. Forgetful is when you misplace your car keys, not a dense amnesia. Do you warn your patients that some people retain their memories but are chemically strait-jacketed and will be unable to resist or communicate with the personel? In other words, just how much do you divulge to your trusting patients? And if you do not inform them of the effects and side effects, why is that Doctor? Why does it seem that you Doctors do not err on the side of caution? Knowing what you know now about how a LOT OF US have an adverse reaction to Versed, are you even considering NOT injecting this poison like it's saline? From my questions of fellow patients (personal friends, not including those on-line), 8 of 10 who have recieved Versed would rather not have it in the future. 5 are adamantly going to refuse it. Many couldn't even understand why they had a lapse of memory at the hospital which unnerved them completely. Since I told them what the drug was (Versed) they are going to choose not to have it! Does this sound like we all just love it, as you say? My own thoughts on this are that you people don't give a damn about the patient, you are looking at how much easier it is on YOURSELVES to slip us a mickey. A compliant zombie is infinately preferable to an awake, questioning patient, isn't that the true reson you love Versed? We can be de humanized with 1 or 2 mls of poison, turned into slabs of beef, with no will of our own and (usually) no memories of the procedure. PS I had Fentanyl with nausea meds and a beir block. No memory loss, no rude awakenings, but I was very aggressive about the Versed/GA. Luckily I had a great CRNA this time who actually cared about ME, and not just himself.

Carole and Larry said...

WOW I stumbled on this incredible site when I was searching in the Tampa Bay area for a place that will do a colonoscopy without sedation. I have had one before, I only had Demerol I watched the whole thing and I left the hospital 30 minutes after getting back to the recovery area. That was Chicago, now I am here and due for another one a procedure that takes 20-30 minutes and they want me to have MAC with Propofol and Demerol. I object. As an RN let's think about the reasons these drugs are given besides to "relax" the patient. It makes the doctors and nurses work easier. It really does. They have an unconscious aka quiet patient in the OR while they get that patient prepped for surgery. I saw the post about refusing meds and let me tell you I have refused anesthesia drugs as recently as 11/06 and I was not given those drugs. Do you need Versed? I don't think so. 14 years ago I refused to have the drugs that reverse anesthesia. I know that the staff can wake me up with out those drugs (make you puke too) and the first words out of the CRNA's mouth were "Oh you want to make me work harder, don't you." In a word, do your job. That means they have to "talk" you awake. It is really nice to wake up that way. You hear the voices in the distance and then your eyelids flutter and the words they are using to wake you are louder and it is just very pleasant. I did it again this past November, had a marvelous anesthesiologist whom I truly respect and again those same words were said "You want me to have to work." Yes, I do, I expect it. I also refused preop meds to "dry me up" because I had been NPO for 13 hours already. I do give this last anesthesiologist a lot of credit, I told her there would be no drugs till I knew what drugs she was going to use. When she said Midazolam I said no. We went with Propoful induction. I still had some "anesthesia brain" as I call it, and I agree that it is an awful thing to deal with. Hell I am still trying to find an endoscopy center that will do my colonscopy without sedation. It doesn't hurt - a little discomfort vs amnesia, I will go with a little discomfort. Again why do I need it? To make their work easier of course. It also adds to the bill. Let's NOT forget that.

Anonymous said...

I received Versed but remember every frightening and painful moment of my procedure. I was combative and had to be restrained. My doctor yelled at me and told me to calm down. I would have thought an anesthetic would have calmed me down!!! Maybe that should have told them that something wasn't working. Never again. It was the most frightening experience of my life and I remember every second of it.

Jackie said...

Anybody who has had a bad reaction to Versed, I requested Fentanyl without any sedative drugs ie Versed, Valium etc. for my second surgery on the same spot where I had the last. It worked beautifully! No pain, no amnesia, no unpleasant awakening, nothing. It was GREAT! I stayed awake, talked to the Doctor, my blood pressure never wavered, nor did my heartbeat, I was certainly NOT traumatized by being awake and aware in the operating room. These last items I mention only because they are a part of the miserable excuses that the medical "professionals" use to justify Versed. None of the reasons that were used on all of us who were injected with Versed are valid. Versed is used for the staff only because they don't give a damn about our mental health.

CNP said...

For people that want to be so intuned with their medical care, it would seem that the anesthesiologist's are getting a lot of blame for not specifically stating that Versed would cause amnesia. If you specifically asked to not receive Versed and still got it then that is negligence. However, if you research the amount of recall people have during surgery you would understand why Versed is a necessary part of the anesthetic. I respect your thoughts and personal opinions and preferences to not receive the drug and think that is quite appropriate. However, I think if you started a sight for those who got Versed and appreciated it, you find that you are in a very minute population. One person commented about forgetting things several weeks after the procedure, the likelihood of that being related to Versed is also minute and most likely not the cause of her forgetfulness! To a lay person, maybe even a litigious person, it would seem as though the doctor is being deceptive or secretive, but in all actuality only providing the standard of care! Some suggest that their privacy was violated, if you are in the healthcare system seeking care, your privacy is being violated whether you are coherent or not! Anytime you step foot in a doctors office or hospital your privacy is compromised! For future use, Versed is something to relax you, so the provider was not lying and to say your in touch with your care and then to blame someone else for medications you received is an oxymorone! If you had done any research about the planned procedure you were going to have I'm pretty sure that it would have explained the medications you may or may not receive, then you would be in touch with your care, but certainly it is now accepted in our society to accept no responsibility for ones own actions and to always seek someone else to blame! Please do not misinterpret my comment, if you were given Versed after specifically requesting not to have it, that is indeed NEGLIGENCE. I am pretty sure that prior to your procedure you signed an Informed Consent form that if read thoroughly may have even disclosed those things, but most importantly you signed it, stating that you had INFORMED Consent!
Matt

Carole said...

Let's never forget you have the right to refuse the drug-it is not a necessary anesthetic medication. Like Jackie mentioned Fentynal is a much better choice. I have had it twice coming out of surgery for pain when I did not want sedation an dit works like a charm. I am having a procedure tomorrow and I already did my pre-ops and I had them write on my chart NO VERSED in red ink in capital letters. My choice!

Carole said...

http://www.anesthesia.med.va.gov/anesthesia/page.cfm?pg=55

Thanks CNP due to your posting I went to this site, and it is quite an education - and the stats are not as alarming but if you are one who has had this experience than it is bad. However-I maintain it is the easy way out to give an amnesiac as opposed to other ways of watching for intraoperative awareness - those were the days so to speak when the anesthesiologist actually did a physical exam and a history and physical-not so any more. Previous experiences should be looked into very seriously and I had what I call anesthesia brain for about 2 months recently but I blame it on all the agents not just Midazolam. I have had wide awake surgery with only a local anesthesia and been zapped with the Bovie in an unanesthetized area, I remember it well, I got over it. I had an emergency C-section before Midazolam and I can tell you I felt that first incision and we had no choice - I don't remember it as pain I remember it as it happened but I got past it. Bad things happen now and then, we can't avoid them in a medical setting. Every one is different. I think for MAC anesthesia there are other choices than as some put it here "lala land". Every one metabolizes drugs differently and believe me I have seen some strange reactions in my career to drugs that other people handle fine. I do think some of the problems in anesthesia are caused by the drugs in combination with fear, anxiety and other medications people take. Heck they are not always honest about what they are taking and we don't know if supplements are reacting with anesthesia meds either. It is scary-

CNP said...
This comment has been removed by a blog administrator.
Jackie said...
This comment has been removed by a blog administrator.
Carole said...

Jackie - you are most welcome. I had to have MAC anesthesia last week for a colonoscopy and the MD and I had a nice chat. We went with Propofol only and while I was a little fuzzy when I first woke up, I remember the entire day (but not the procedure which is fine with me). Keep standing up for yourself, you have rights.

CNP said...

Propofol has similar response, just shorter acting. The difference is probably in the price of your procedure. Most endoscopies have nurses administering Versed & _____ enter narcotic. MAC involves anesthesia which means your procedure is probably atleast a thousand dollars more for the procedure.

NinaM said...

I'd like to start off by saying that I think the people running this site are doing an injustice by creating a negative image of the drug Versed rather than redirecting their frustrations at their health care providers that failed to educate and inform them. People suffering anxiety and fear pre-op by far outnumber those with curious minds. I, personally, am one of those curious minds that likes to know everything and watch everything happen. I had a colonoscopy and was offered Versed along with a full description of what it does, how I will feel and what I will remember afterwards and opted not to have it. I was offered Versed once again pre-op for major GI surgery and in this case I chose to go with the Versed due to the fact that I had to receive an epidural and because of my complicated scoliosis, it was expected to be difficult to place the catheter in my back. I have to say I don't mind being "out of it" and only remembering tidbits of the 10-15 min it took to place my catheter. I can't tell you how many people I know that cannot stand to be in hospitals or have anything to do with surgery. This preformed anxiety and fear not only causes discomfort for the patient, but it hinders the surgeon in doing the best job he/she can do. I'm sorry but no one can do what these doctors can do and frankly, whether you like it or not, they do know better. Your life is in their hands so if putting a curious mind to rest in order to perform better and attain a better result bothers you...get over yourselves. There are bigger things in life to worry about instead of what you missed when they were prepping you for surgery or checking your colon for abnormalities or pulling your tooth out. I'm not saying a patient should not have the right to know what's going on but if you can go on with your life not knowing the tedious details about surgery that a common person doesn't understand anyway, what's the big deal? There is a principle at hand, that I know but this site is bashing on Versed as though the drug is a bad thing and can't be put to good use. If you had a bad experience with an unprofessional or uninformative health care provider, complain to the proper authorities. And for those of you reading all of this and are now scared to be given Versed...let me be honest with all of you, I get no benefit of supporting or attacking the use of Versed, and here's exactly what you can expect: it's as if you drank too much and are going in and out of consciousness. You WILL have impaired memory and only remember small tidbits of your experience. In case you're wondering, the half-life of the drug is 1-4 hours. And in case anyone here is getting a colonoscopy for the first time and may be considering Versed, personally I say it's not necessary. There is discomfort without it but it's tolerable so all you curious minds, enjoy the show. And I'm sure I'm going to get alot of negative feedback to my post but let me prematurely respond by saying this again, if you were misinformed or uninformed, REDIRECT your frustrations to the health care providers that did an injustice to you. I'd rather have Versed than be knocked out by general anesthesia anyday! Isn't it scarier that your respiration is dropped so low that you could not wake up (not very common) from general anesthesia?

-Tim said...

NinaM said...

"I'd like to start off by saying that I think the people running this site are doing an injustice by creating a negative image of the drug Versed rather than redirecting their frustrations at their health care providers that failed to educate and inform them."

We long ago discussed this very issue - who, or what, should we be targeting? Kirt has even stated that he does not object to versed so much as how it is used. I disagree, feeling that I can never trust anyone with an amnesia drug. We completely urge people to complain to the health care providers. One issue we see constantly is, frankly, lying and deception by the Versed zealots. Hence our zeal to alert people to both the existence and misuse of this drug. Too many people hate this drug, were outright lied to, and never want it on board again. It is obvious that they go out of their way to never mention nor describe this drug. It is unethical to be pumping this stuff into people without their knowledge and proper consent. How is reporting the FACTS "creating a negative image" ? Do note that the majority of posters here agree and are grateful to have this site.

"People suffering anxiety and fear pre-op by far outnumber those with curious minds...."

Forget the curiosity! This is completely beside the point. It is not that I want to remember (I DO - because I will never trust medical people ever again). The point is I don't want my memory targeted by a chemical. I have had too much crap happen to my system already for one lifetime, and I demand that my memory be left the f--- alone. Clear ???

As another engineer said, Versed is simply unnecessary for surgery. I personally have had a LOT done to me while awake and it was never a problem. This also enters the zone of "If it ain't broke, don't fix it!"

"This preformed anxiety and fear not only causes discomfort for the patient, but it hinders the surgeon in doing the best job he/she can do."

This is beside the point. There are other anxiety relievers that do not cause amnesia. The world was fine before Versed came along. It will be fine when Versed goes away.

"I'm sorry but no one can do what these doctors can do and frankly, whether you like it or not, they do know better. "

B.S. That is a blanket excuse they'd like us to swallow so we shut up and roll over. This Versed Buster business has put me in touch with a lot of patients, and I have personally been through a lot of medical scenes in recent years, my own as well as that of friends and family. The arrogance and incompetence of the medical world is astonishing. If you're not afraid of medical people, then you should be. YOU are committing the injustice by telling people to not scrutinize them. Hell, after my doctor found my hernias, he sent me to a surgeon who I did not use - I would not let that guy come to my farm and take the rectal temperature of a cow, never mind have him operate on me. Funny, in a world where people whine so much about personal responsibility, you appear to encourage people to just "suck it up" when it comes to medical matters - perhaps the most serious decisions people can make. It is foolish to not be all over them, putting every detail under a microscope. It is a case of "ya snooze, ya lose!"

" There is a principle at hand, that I know but this site is bashing on Versed as though the drug is a bad thing and can't be put to good use. "

I don't think it can be. If I were dictator of earth, it would be gone, period. I no more trust people with versed than I would trust a band of teenagers I just met with keys to my house. It floors me that amnesia drugs even exist. The obvious zeal to not only use versed but to be deceptive about it should raise a red flag with anyone.

" I'd rather have Versed than be knocked out by general anesthesia any day! Isn't it scarier that your respiration is dropped so low that you could not wake up (not very common) from general anesthesia? "

Either scenario poses risks. And Versed has long lasting effects they deny. I understand that if, say, I needed open heart surgery, it would require more than an aspirin and a cotton ball wet with isopropyl. But I want the minimum amount of drugs that they can *honestly* do the job with, and I will not be using any amnestics under any circumstances.

Check out comments like these:

www.netwellness.org/question.cfm/43700.htm

"I`m a nurse and we love versed in our pacu unit - it makes our jobs easier and it`s like taking care of zombies. Not one nurse I know will ever knowingly allow having versed."

From another RN:

www.medicalnewstoday.com
/youropinions.php?opinionid=11517

Bad Reaction To Versed
posted by kent on 01 Apr 2007 at 8:00 pm

"I had Versed two days ago for a dental procedure. It was the most terrifying experience I've ever had. It felt like I was being forced up a vacume where all sides of me were many mirrors and glass, and I had no control over this as I felt like I was racing in the air trying to reach the end of the "glass" but it never ended.

I know this sounds crazy, but I'm still recovering today, and I get terrified when I even think about it. (I'm 56 and an R.N.).

Thought that I was dying. I was trying to scream but no one could hear. I did notice the shadowy shapes of the dentist and his assistant as they hovered above me, but I believe I came very close to having a heart attack.!!"

If you read all the reports out there (and here!) and still want versed, please go and use any that was allotted for me . . .

Jackie said...

Dear Ninam, although I am happy that your brain fuction returned enough to post here, let me clarify a couple of things. First of all this web site is for VERSED SUFFERERS. We have already heard the obnoxious and self serving diatribes about the sanctity of Versed by its zealots. This is a BAD DRUG. I have heard all the excuses and pretend reasons for using Versed. Too bad that not one person who injects this vile substance into patients is willing to be honest about the reasons they use it. Ever wonder why? With the medical community having orgasms over Versed, I say, it's a good thing to have the opposite viewpoint. Fair and balanced. We have been harmed by this drug. There is a commonality between us that is far beyond simply a hand wringing exercise over Versed. We all experienced this poison and it caused the exact same symptoms, so something else is at work. There is a physiological reason for our symptoms!!! Get it? I can't tell you how relieved I was when I found out that I was not the ONLY person to react badly to Versed. To find that, contrary to what my medical team told me, that I was not crazy and that others have had the identical reaction to Versed! Why would you want to take that away from us and anybody else who has had Versed? I would rather die than have Versed again. This is the kind of extreme reaction that one should expect from a drug that turns people into zombies. I hope that every person who stumbles onto this site will question their medical providers and refuse Versed lest they have a "bad trip" like we did. Watch that TV commercial on drug use again with the egg and the frying pan. "This is your brain on VERSED!"

T. said...

I am an anesthesiologist in private practice and am aghast that something we do with such good intentions has the potential to cause the intense suffering described here. I am also distressed that so many who have had such a horrible experience with Versed now feel that all practitioners of anesthesia are, at heart, "sneaky," disingenuous, and comparable to perpetrators of date rape. Please know that from what I know of my own colleagues, this is not the case - we went into this profession wanting to ALLEVIATE suffering, and in fact administer Versed for that very purpose, and if we were educated about the uncommon but very real pain this has caused some patients, we would most certainly as a group seek to learn more and modify our approach.

Most of my collagues do give Versed frequently with the intention to used it for what it was designed to do: alleviate perioperative anxiety. It was not to my knowledge developed for its amnestic properties but rather for its anxiolytic properties, with anterograde amnesia a side-effect largely welcomed by the majority of patients facing surgery.

Personally I do not administer it routinely. I believe an anesthetic should be thougtfully designed and conscientiously carried out for each individual, and frankly if someone's anxiety can be mitigated by meeting with me and expressing his or her concerns to me, I would prefer this method of anxiolysis. On occasion I meet a patient who is uncomfortably nervous preop, and then I do offer Versed, but I also warn the person that it will "wipe out" her memory of the events surrounding the administration of the drug, including conversations, entering the room, having monitors placed, etc. Most people readily accept this possibility, and when I have gone on rounds to visit patients after their surgeries, I do try to elicit any complaints they may have had about their care.

I can understand how so many people might feel violated by a clinician's failure to announce the administration of a drug or its side effects, and how that could come across as "sneaking a little Micky" in. To be frank we are not in the habit of explaining each syringe we hook up and inject for many reasons, including the length of time it would take to explain each and every drug, which admittedly becomes more of an issue right before general anesthesia and intubation, prior to which as many as 4 drugs can be injected into the IV in rapid succession, all with a good purpose, all given with the best of intentions, to protect patients and ensure their comfort. One of them, Propofol, one of the most widely used anesthetics in the world, also has some amnestic properties, but it has become the staple of anesthesia in recent years.

I guess I've taken up a lot of space here, but I just wanted to speak for the many well-intentioned anesthesiologists I know, and say that contrary to what may have come across to many in the past, we do intend the very best for our patients, we do care about the suffering of our patients, and I for one am deeply troubled that those who have described their experiences here have been through such a terrible time. I will continue to be judicious in my use of Versed, which I do believe has its place in the practice of anesthesia, and I will strive to continue to have candid conversations with my patients about the anesthetic plan.

Carole said...

"T" wish there were more like you out there- CNP my GI doctor will not do a colonoscopy without MAC anesthesia which means yes I had an MD in there and he dosed with the lowest starting dose. I remember every thing from administration as I comfortably drifted off to waking up 20 minutes later and being given the results of the screening. I left the hospital 10 minutes after that. Memory intact. The other patients in the PACU had Versed/Demerol and were groggy and sleeping while I was on my way to dinner. My comfort to me is worth the "cost" as you put it of MAC anesthesia - sometimes you have to give up control and it does work.

Mlgsings said...

I'm having an umbilical hernia repair on 9/1 and the plan is to use MAC. I was told it's basically a twilight sleep anesthesia plus local and also that I would remember nothing of the procedure. I've had a problem with the idea of amnesia as a main element of sedation for a long time. I want to be comfortable, but I want to be aware of what's going on. Someone from anesthesia is supposed to call me 1-2 days before surgery so I get to discuss my concerns in advance, but I don't know how to get it across w/o sounding like a flake and also if I have other options than versed. I'd appreciate anyone's comments.

-Tim said...

Many people have claimed that you can refuse Versed and the person who did my anesthesia claims that you don't even need to remember the name of the drug.

You are not a flake, and you should not worry about what those birds think. You are the customer!

Tell them you don't want Versed or any other amnesia drug.

There are other anti-anxiety drugs that can be used that do not cause amnesia.

I have heard of many hernia repairs done under local, so don't let them BS you.

Mlgsings said...

Tim, thanks for the vote of confidence. Your profile says you're from VA. So am I, I'm in the Hampton Roads area. Medical care is very conservative here, I had to see 3 surgeons before I found one that will repair an umbilical hernia under local. The other two said it's not feasible. I even called the surgery dept. of our local med. school and was told they only use general for these types of repairs. This is so not in keeping with the times.

My stepdad has emphysema and severe osteoarthritis. He needed double hip replacements and the orthos at a major teaching hospital/medical school told him he could not have the surgery because he could not be put under general and they absolutely would not consider spinal block. His lung specialist at same location was in agreement. He got to where he could hardly get up and walk at all and his primary care doc arranged for him to get a scooter. Then he found out about an ortho surgeon 25min away (he lives in a rural area and was traveling almost 2hrs to get medical care) went to see him and last Dec. had his left hip replaced, then his right in Feb., both under spinal block with a little sedative. He was awake and aware for both surgeries, just mellowed out, and he recovered just great. He's up and about doing pretty much what he wants to do now. He just turned 75.

I understand that ortho does a lot of his procedures this way and is totally comfortable with it, as are his patients.

The arrogance of some people in the medical field never ceases to amaze me, and it goes to show you that even teaching institutions can be far from the "cutting edge" (pun intended).

jackie said...

I and others have had very good success with Fentanyl and a nausea medication ONLY! If you are not squeamish and can hold still, I don't see any reason why this approach would not work for a hernia operation. Talk to your healthcare providers BEFORE you get to the hospital to get all this straightened out. Don't buy into that "the anesthetist will see you before your surgery" Once you are on their turf, they sometimes get a little out of control over YOUR body.

Mlgsings said...

Thanks Jackie. Someone from anesthesia is supposed to contact me a couple of days before my surgery, so I already have what I want to say/ask planned out. I understand I'm just getting a phone consultation, which bothers me a little b/c I can't have my husband there with me, but I'm considering setting up a 3-way conference when they call b/c he knows very well how I feel and he's got my back. My hubby had a carpal tunnel release in 1991 with local only, no sedation of any kind, and he was okay with it (I understand some sedation is more the norm for this procedure now even though it's a quick 10-15-min deal).

Unfortunately we live in a culture that likes to be "comfortably numb" to everything. Not only do people not want to feel pain, they don't want to feel unpleasant feelings to the point they accept drugs to quell the feelings or worse yet, take away any memory of them. I birthed 4 children vaginally with no pain medication. Did it hurt? Heck yes! But I prepared myself and was able to work through the labor and delivery each time and come out of each one thinking "I made it, and I could do this again!" Some people think that's nuts, but how did the human race make it before epidurals?

Anonymous said...

I had Versed before a laparoscopy and was glad I had it. I told the anesthesiologist that I was nervous and he gave it to me. As he rolled me down the hall I became very relaxed and we talked for a few minutes. I told him the drug was relaxing and asked him what it was and he said Versed. He wheeled me into the operating room where I met the nurses and spoke with them for a few minutes before the general anesthesia was administered. I woke up about an hour later in the recovery room feeling fine.

I will not hesistate to request it again if I need further surgery and am feeling apprehensive. I mean no disrespect but I don't quite understand how you can get upset about not remembering a procedure when you are asleep???

Mlgsings said...

anonymous, I'm not having general anesthesia for my hernia surgery. If I was of course I wouldn't remember anything while under it - because I would be unconscious. Even if I chose to be put to sleep I would not want to be premedicated with something that causes amnesia, especially without being informed and given the chance to consent. The sights and sounds of the OR do not bother me, as long as I don't feel any pain, I'm fine. I know this is not the choice everyone (actually most people) make, but it's my choice and it should be respected.

-Tim said...

Anonymous:

You completely miss the main points made by the folks here.

The first poster here had versed forced on him. I was similarly deceived into using it. I do not want my memory fooled with under any circumstances. That is my right. If I am not unconscious, then I want to have my memory intact regardless of what happens to me. Versed sometimes does not work as planned. Horrible episodes of paradoxical reactions have occurred. It has caused various nightmarish experiences which people recall all too well. There is evidence that subconscious memories can remain after having versed. In short, Versed is a rather imperfect drug and it is abused by those who are supposed to be taking care of us.

Anonymous said...

I had cosmetic bilateral blepheroplasty (eyelid surgery) and was given Versed.

I also remember everything. I felt drunk and remember telling everyone that I loved them. I also remember feeling so happy that I announced before surgery that I wanted to hop on the table and sing Christmas Carols. The nurses just told me to calm down and try to relax.

The only "anesthesia/pain killer" I received from the doctor was shots of novacaine around my eyes to numb the area. I felt every snip and every stitch. I remember the blood dripping in my eyes. I kept telling them that I could feel everything. They didn't seem to care. They just kept telling me to try to relax. I kept lifting my head during the surgery and they kept holding me down. I told them the back of my head was hurting and the doctor finally realized that they had forgotten to put a "donut" under my head so I was just laying on the hard table with nothing under my head for 4 hours. I was so distressed by the pain that I remember starting to go into shock. I told the doctor I was going to vomit. The nurse sounded scared and said my blood pressure dropped and I was going into shock. I thought I remembered her saying my blood pressure was 70/40 but I don't even know if that is possible? The doctor had to stop the surgery. They propped my feet up and wrapped them in ice. That seemed to work and he continued the surgery.

When I saw the doctor for follow up after the surgery, I told him that I remembered everything and that I felt all of the pain. He just said that I shouldn't have remembered anything. I told him that I kept having nightmares about the surgery and he just told me that I needed to forget about it and let it go.

All of this happened about 7 years ago. I was supposed to go for a follow up surgery but was so traumatized that I never went back.

I don't know if everyone experiences the same pain while in surgery and the Versed is just supposed to make them forget? It was like living through a terrible torture. I really wish I could forget it.

I know everyone on this website says they want to remember but I wish I could forget.

Do you think it is right to inflict pain and then make patients forget about it which seems like what was supposed to happen except that Versed didn't work on me?

I think what bothers me the most is how I kept telling them I could feel everything and they did nothing to help me. Is this standard of care since Versed came along? Are doctors and nurses knowingly inflicting pain to the point that it is common for patients to tell them and be ignored since they believe that the Versed will wipe out the memories?

I thought my situation was a fluke but now wonder how many patients this doctor puts through that kind of pain but justifies it believing that patients will forget about it.

-Tim said...

Anonymous wrote:


" When I saw the doctor for follow up after the surgery, I told him that I remembered everything and that I felt all of the pain. He just said that I shouldn't have remembered anything. I told him that I kept having nightmares about the surgery and he just told me that I needed to forget about it and let it go."

That immediately raises red flags. Clearly, the doc should have been more concerned.

" I don't know if everyone experiences the same pain while in surgery and the Versed is just supposed to make them forget? It was like living through a terrible torture. I really wish I could forget it."

Versed is *not* a pain killer.

" I know everyone on this website says they want to remember but I wish I could forget."

The problem I have with this scenario is that there should be nothing unpleasant about your experience in the first place. either knock people out or kill the pain in the first place. Versed is an evil half-way (half-assed!) measure: They can let you suffer thinking (hoping?) that you will not remember. This is not the same as avoiding the problem to begin with!

" Do you think it is right to inflict pain and then make patients forget about it which seems like what was supposed to happen except that Versed didn't work on me?"

No, I absolutely do not think it is right. It is sick and twisted. This Versed is a perverse invention.

" I think what bothers me the most is how I kept telling them I could feel everything and they did nothing to help me. Is this standard of care since Versed came along? Are doctors and nurses knowingly inflicting pain to the point that it is common for patients to tell them and be ignored since they believe that the Versed will wipe out the memories?"

Unfortunately, yes, this seems to be the "standard of care" since Versed came along.

" I thought my situation was a fluke but now wonder how many patients this doctor puts through that kind of pain but justifies it believing that patients will forget about it."

Given the common arrogance and callousness that is being constantly reported, unfortunately, your situation is not a fluke!

Laurie said...

Having a colonoscopy in a few weeks. Anyone know if the anesth. dr. will Rx IV valium?

Would prefer that to the possible horrors of versed.

Sheesh, this scares the heck outta me

thanks for your help. glad I found this place

Laurie

-Tim said...

Laurie:

From what I have read, it appears that most people don't have a bad experience with colonoscopy. As far as versed goes, just say no! There are docs out there who will perform colonoscopy without versed. Make sure you find one! Make them sign a form.
If your current doc gives you any grief, find someone else!

Mlgsings said...

Laurie, when Katie Couric had her televised colonoscopy a few years ago, the doc gave her only demerol, and she said it wasn't bad. Some people request no meds, but if you would feel better with something, ask for a narcotic only. They use either demerol or fentanyl.

Anonymous said...
This comment has been removed by a blog administrator.
Anonymous said...

Three years ago I had a routine gynecological procedure done under what I was told would be "local anesthesia." A few years earlier I'd had nose and jaw surgery with local anesthesia and had no problems whatsoever, so I expected the same results. I wasn't told I'd be given Versed this time.

I knew something was wrong when I became very dizzy right before the procedure. The next thing I knew, several hours had gone by and I was being told to wake up. I felt like I'd been hit by a train. I literally felt as though I'd been in a fight. I was told I'd had a bad reaction to the drug they gave me. It caused my blood pressure to drop and they had to give me an antidote (Anexate). My doctor was gone and I felt the nurses were treating me strangely, so I asked what had happened but they only gave me vague answers, like, "You had a hard time in there, but it's over now." To this day, I think I must've struggled or screamed or behaved badly. It's embarrassing to think I was out of control. I was sent home in a semi-conscious state and I slept nearly twenty-four hours straight. It was a miserable experience.

This morning I had the same gynecological procedure done at the same clinic. I had a long talk with my doctor before I agreed to have it done. It was a necessary procedure and I'm limited by the constraints of my HMO, so I figured I had no choice in what would happen to me. Fortunately, I got the same anesthesiologist as last time, and when she read my chart she remembered me. She told me I'd been given Versed and she agreed I'd had a bad reaction to it. She didn't seem to know what to do for me this time, though, until I told her point-blank that I wasn't squeamish and I didn't care if I remembered the procedure. Apparently this is unusual! After some discussion she agreed to give me a much lighter dose of Versed. I remained awake through the procedure, and was fine until I suddenly blacked out in the recovery room. When they woke me up and gave me juice I felt okay for a few minutes, then I vomited the juice up. When I got home I slept about six hours, and I've been intermittently groggy for the last couple of hours. I'm going to stay home from work tomorrow because I'm not sure how long I can stay awake. Apparently that "much lighter dose" of Versed wasn't light enough for me.

I'm lucky to have a doctor who listens to my concerns, and I'm going to ask that the words "NO VERSED" be put in my chart. Now that I know the name of this drug and the problems it causes, I'll be more informed if I need another procedure. I googled "Versed" this evening and found this website, and I want to thank you for informing the public about the overuse and misuse of this scary drug.

Mlgsings said...

anonymous, thanks for sharing your experience. After you had such a bad experience the first time I can't understand why the anesthesiologist was so hung up on using versed again.

I was prescribed xanax (another benzodiazepiine) for anxiety a few years ago. It was a small dose to be taken 3x/day. I took my first dose at bedtime and was so wired I couldn't sleep at all. By the time I went to work the next morning I was okay. Then I took the next dose after I got to work. I was a nervous wreck the rest of the day. I was very anxious and shaky and felt like screaming (though I didn't). I think I took one more dose that night and again had trouble sleeping. I couldn't believe a sedative could have that kind of affect on me, but I quit taking the stuff and told my doc. I can't understand why the doc gave me that medicine to take more than at bedtime in the first place.

Anyhow, if I reacted that badly to a very small oral dose of one of the "lesser" drugs of that class, I hate to imagine how I'll react to taking one of the big guns like versed. I'm having an umbilical hernia repaired 9/1 and it's supposed to be done with MAC (local with twilight sedation) b/c I requested not to have general anesthesia. I will be sure to relate my experience to the anesthesiologist when I have my consult with him or her, and ask if there's any alternative. I really want to stay awake if at all possible so I don't want propofol. I'm afraid I'll be told I should have a spinal, which I'm not keen on since it could mean hours in recovery till I get the feeling back in my legs.

Anonymous said...

Mlgsings said...
"After you had such a bad experience the first time I can't understand why the anesthesiologist was so hung up on using versed again."

She seemed perplexed that a patient wouldn't want it. I think she was so used to giving it to everyone that she couldn't come up with an alternative, and her best idea was to give me a lighter dose. Also, my HMO treats humans like widgets. If you're a square peg, they'll hammer you into a round hole even if it kills you. I'm actually glad I had this second experience with Vresed, because now I know exactly what it is and what it does to me - and I won't let it happen again.

Jackie said...

I would like to opine that Versed has done more then harm patients. I truly believe that Versed aka Midazolam has harmed the quality of care that we recieve and it has harmed the Doctors and Nurses that inject it. It seems to be so much easier, not to mention entertaining, to poison the minds of patients. Better than to have an actual encounter with another person (the patient), and they have become calloused and indifferent to patient suffering. The "patient relations" woman at the hospital where I went actually told me that "the MEDS" make people scream in agony. Well, the patient is screaming in agony because they are in major distress. The fact that they don't remember it doesn't mean it isn't excruciatingly painful. This lack of conscious memory has caused Doctors and Nurses to become sadistic and uncaring if their charge exibits pain. I wonder if the medical profession has adequate mental health screening for their practitioners to weed out the psychopathic torturers or not? What a special job for S&M lovers! All quite legal... Just shoot up the patient with an amnesia drug, begin the pain, and watch them SCREAM! Who gives a damn about patient comfort or care? They have Versed now. I don't feel a bit sorry for the Guantanamo Bay prisoners or the silly Abu Graib fiasco when we have maniacs maquerading as "healers" who are by far more proficient at REAL torture. I can see by the unsympathetic and acusatory tone of the few medical folks that have deigned to honor us with their presence here, that they have no intention of letting us get away with resisting their Versed injections. They blame us for our bad reaction, and prove Tim and Kirt's point that they are liars and con artists. I go one step further and say that they are psychologically impaired by exposure to Versed.

Anonymous said...

Jackie,

I find your ideas very thought provoking. Since my very negative Versed experience earlier this year, I have struggled to understand what appears to be a strong bias in the medical community to overuse this drug. I understand from reading this site and askpatient.com there are many people with medical anxiety who truly desire to have their memories erased. On the other hand there are many, like you and me, who find the Versed memory destroying experience very troubling. Yet in spite of this large difference in patient desires and reactions, the medical community seems intent on using this drug on everyone for certain medical procedures, regardless of a patients need for sedation. In some cases (such as my own) there also seems to be a deliberate effort to keep the patient uninformed about its amnestic properties. Maybe they are afraid patients would refuse it if they knew?

So why do they push it? You suggest the doctors and nurses have been harmed by administering it to patients. Much like the adage that 'power corrupts'. Where people move from simply having power to wanting power and then abusing it. And so it is, maybe, with powerful mind altering drugs like Versed. These people go from using it for medical necessity (in some cases) to wanting to use it and desiring the power it provides over the debilitated patient?

John

Jackie said...

In a word John... BINGO!

Anonymous said...

My partner went into Leighton Hospital Crewe for a hernia operation she told them she didnt want her knickers removing and they agreed. They then gave her versed and forcible removed her knicker sin the most vile and perverted way due to the effects of versed which enhances sexual feelings she dream t she was being stripped by a gang (which she was) and that she was going to be gang raped. As she was over weight they could be bothered to give the drug as recommended ie 1-2mg over 2 mins and then wait 2 mins. They gave her the lot in one go as it would have taken 20-40 mins to give it properly. She woke during surgery 3 times screaming in pain 10 times worse than having a baby. Then her heart rate dropped from 80 bpm right down to 38 bpm she then believes she died an expert says this was do to the versed.

The hospital try to claim she was dreaming it. I have done a website telling the full horror
http://www.leightonhospital.ascandal.com/

please take a look

Anonymous said...

get over your paranoia. or do your own surgery under life endangering general aesthesia. by the way, you won't rember anything from general either.

Anonymous said...

Dear anonymous, it is not paranoid to be afraid of something that is real! Watch your definitions... I had the damn general anesthetic too you cretin, and I had declined it. Versed allowed these dirty bastards to continue THEIR idea of what I was going to get without objection from me. Quit trying to defend this poison Versed as a way to avoid a general anesthetic will you? I got both and I'm sure that many, many others have gotten both! With a general you are not SCREAMING AND WRITHING IN PAIN EITHER ARE YOU? Stupid idiot.

Anonymous said...
This comment has been removed by a blog administrator.
Anonymous said...

Despite the great advances in anesthesia, pain control and life saving procedures in this country, Doctors, Medical Staff and Patients need to be respectful of the physiological and psychological differences between people so that everyone can have the best lifesaving and healing care available. Only through honesty and open dialog can care improve. The truth is Versed IS a real problem for many patients. We all just need to be aware of that and proceed accordingly. However, there are prejudices in both the medical industry and patient attitudes that often cause problems. This site is valuable because it is one method of communicating about the issue and it is reassuring to be reminded that I am not the only person who has had a bad reaction to Versed.

Several years ago I had to go into Dartmouth Hospital for a heart catheterization procedure. I was told I would be awake but "relaxed" because it was a short-term, outpatient procedure being done only to check out my congenital arrhythmia problem.

Just before the procedure I met the Nurse Anesthetist and told him I had had some bad experiences with the medication and/or anesthesia for a prior procedure (suppressed breathing, low blood pressure and prolonged nausea) and told him that I wanted to know before hand what medications his plans to keep me "comfortable" would involve and that I as I knew it was a very short procedure, I wanted, and felt I needed, only the bare minimum of medication. He immediately patronized me (although he probably thought he was reassuring me!) saying, "Don't you worry, I know how frightened you are and I'm here to take care of everything. I'm the expert you're the patient; you do your job and let me do mine." I was not reassured (and in fact I learned later that my husband was so upset by the guy's attitude that he almost suggested I leave and reschedule with someone else) but as I was already there and wanted to get it over with, I went ahead with the procedure because I trusted my cardiologist who seemed to trust the Nurse Anesthetist. BIG mistake!

I remember being wheeled into the OR talking about the procedure and my dogs, then suddenly "awakening" in a disoriented panic with the distinct impression that someone was running a blowtorch along my neck. Then, suddenly I guess I was out out again as I do not remember much more until I woke up in recovery feeling absolutely awful -- the most horrible sense of pain, doom and general malaise ever.

Obviously, despite the concerns I had clearly voiced, they had paid no attention to my previous experiences. Afterward, despite receiving nothing except "minimal" amounts of Versed and a couple of shots of local anesthetic where they inserted the catheters, I trouble breathing for several and shook like crazy for hours afterward and experienced nausea and vomiting for several days. For weeks afterward I felt dizzy, unusually tired, lethargic and moderately depressed. Despite usual good health and an even, happy temperment, I just could not seem to get into "recovery" mode. I had recurring nightmares, where I could recall fragments of what had happened in the OR, but could not synthesize them into a context that I could consciously deal with so I could get past them and move one. This lasted for months!

In addition the Cardiologist had the effrontery to write in my chart that I am "paranoid and uncooperative" when in surgical situations and that should I ever require surgery or medical procedures again, it is his recommendation that I not be given the option of remaining awake for even minor operations, but that I should be given only general anesthesia!!! First of all, who is he to make this recommendation? Second of all, general anesthesia often carries many more risks than locals. Third, what kind of MD blames the patient when he or she should have at least the bare minimum of facts that I was able to find out about the possible effects of Versed!?

I researched it all myself and learned that I, like MANY (but not all) people have an intolerance to Versed that may well have to do with individual genetics and their effect on metabolizing the various components of the drug. I also found out that the blowtorch feeling on my neck was the surgical staff shoving a tube into my neck so they could get fluids in me to counteract my falling blood pressure. Had either the Nurse Anesthetist or the Cardiologist bothered to help me with an honest debriefing after the procedure, we ALL could have learned from it. While I have certainly moved on with my life and rarely think of the experience, I am still very disappointed that such an esteemed institution, an experienced Nurse Anesthetist and a Cardiologist I once trusted and respected would have dealt with me is a manner that demonstrated such a lack of professionalism and with so little compassion. I am certainly much more assertive about all my medical care now and encourage everyone to be. And never forget, it is NOT the patients' fault when such things as medication reactions occur. It may also NOT be the fault of the medical staff, but it is their responsibility to handle the situation with professionalism and compassion. As consumers and human beings, we, as patients, deserve that and have a right, as well as an obligation to ensure that we are treated as we should be.

Anonymous said...

I was given Versed about a year ago - twice for dental surgery. The first time around I felt no ill effects; but the second time .. I still feel a vague unease or panicky feeling when I think about it or try to remember anything. I have vague dreams/nightmares about being combative. I remember only the first few seconds - my arms moving - trying to get 'free' and not having any control over my movements - and an assistant holding my arms down. I am not a combative person - very passive is more accurate.

I can't help but wonder what else happened that I don't remember? Why do I feel such anxiety if I even try to recall events?

I think this is a very bad drug for anyone with 'control issues' or has ever been in any kind of abusive relationship.

For me - it was too similar to a time when I had no control over what someone did to me.

I never, ever want to have it again. The amnesia part is scary and I cannot understand anyone desiring this.

And every time I went in for a fwp - they would ask . .'do you have any memory of what happened?" And I would have to say No. But I wanted to ask .. what DID happen? This was a surgery with a not so good outcome - and I want to know . . . what happened to me? Thanks to Versed, I will never know.

Anonymous said...

PS: Again - the control issues. The thought that I was awake - but unconsciously following commands with no control over my body, movements, speech, etc . . or even worse, things I might have said or done without knowing it. . . is a huge trigger for anyone familiar with any kind of abuse.

I wish I had thought more about it before agreeing. It was recommended and I said yes without another thought.

I can't remember - yet I can't forget either.

-Tim said...

I too experienced these weird anxiety flashbacks. They were frequent at first, then tapered off to about one a month, but persisted for almost three years (my surgery was in September of 2004).

I could be anywhere and it was as though an old memory was trying to surface, but could not quite gel. It is like trying to recall someone's name - you know it's there, but it just won't quite surface.

The harder I tried to focus the memory, the greater my anxiety rose . This reminds me of the classic Star Trek episode "Dagger of the Mind" where, I think, Kirk was told he'd experience great pain if he tried to remember the "sessions" he had with Dr. Adams.

jackie said...

My Versed induced obsession over what happened to me has led me on a path to more and more information on how the brain functions even with conscious sedation and amnestic drugs. Apparently scientists have concluded that the conscious memory is separate and apart from sub conscious memory and at least one article I read states that there is an increased level of memory in the sub conscious level during episodes with Versed. Naturally we are unable to access these memories, but they do seem to have an impact on our lives. The dread, anxiety and the fear and loathing of the people surrounding you during your Versed induced brain trauma may well have something to do with them doing and saying things that were unacceptable to you and the FEELINGS have been retained whether or not there is any conscious memory.

Anonymous said...

I do feel fear, dread and anxiety now - even when just going to get my teeth cleaned. I think that I had a bad experience anyway and that last round of Versed multiplied it times 100.

Is it because my last waking thought is struggling and trying to get out of the chair?(Which is so not me). I was afraid anyway because the 2nd surgery was to correct a first one that had gone bad . . so right off the bat . . I'm not wanting to be there and more nervous than usual. Also the surgeon isn't too happy because he has to undo his first masterpiece.

I remember I had to go back to the same people for a 3rd surgery and the fear I felt just to pick up the phone - was not rational. And my continued fear of any procedure - is not rational. But it's there nonetheless. I think I had a very bad reaction to this drug in addition to some very bad memories (real) and some very bad nightmares (not real???)

I'm glad I'm not the only one that feels this way and I hope I never have to have it again.

Anonymous said...

I am being treated for Barrett's Esophagus. I have had a EDG every month for the past year along with an MRI which I was sedated for. The Dr. uses Versed for the EDG procedures.

My problem is I have become very depressed and I thought I was suicidal. I even admitted myself to a physc unit. Is this because of the repeat use of versed? I have to have the EDG every three months now. But I am worried about getting worse. I was a Senior Web Developer but lost my job due to my anxity

Please email me at klroach@kent.edu

Anonymous said...

Disturbing observations by a doctor concerned about the inappropriate use of midazolam:

http://www.apsf.org/resource_center/newsletter/2000/spring/15-letter.htm

This may explain why some of us feel traumatized by our midazolam experience and don't understand why.

Anonymous said...

I had my umbilical hernia surgery yesterday. I had it done with local anesthesia and no sedation! I told the surgeon, anesthesiologist, and CRNA in the holding area that I wanted to stay awake, and they were all perfectly fine with it. They were familiar and comfortable with doing hernia surgeries on non-sedated patients. I was offered a little fentanyl by the CRNA and I accepted. It was a small dose, but enough to calm me a bit and make the local injections and start of the surgery more tolerable. Yes, I could feel pressure, tugging and even some needle pokes from the suturing, but the surgeon added more local as needed and all in all it was tolerable. I went into the OR about 9:40 and was wheeled out at 10:07. At 10:30 they called my hubby into the recovery area, I went to the bathroom to pee, and I was walking out at 10:45.

Everyone was kind, considerate, and eager to answer my questions. No one was critical of my choice. The CRNA was wonderful and most attentive and caring. I was really concerned that I would be brushed off for them to do things their way, but everyone went out of their way to make sure I had the experience I wanted and made it as pleasant as possible.

My husband was quite impressed with the surgeon and it looks like he will be doing bariatric surgery on my husband in the not too distant future.

Mlgsings said...

I forgot to log in w/my Google ID. The previous post was by me, mlgsings.

Anonymous said...

I've been unfortunate enough to encounter the need for several surgeries to repair my kidneys. However, I have been fortunate enough to have a great staff of anesthesiologists that work with the surgeon to prepare my care. The hospital that I prefer to use has a rule that if the paitent does not have a signed consent form in the medical chart indicating that he or she has been fully informed of the drugs that will be administered and that the patient has had the opportunity to ask questions, the surgery will not be performed.

I remember one incident where I was in the Pre Op holding room before surgery. I realized that I had not signed my consent form. I told the anesthesiologist about this and said that I consented verbally. He stopped the IV, went to get a nurse and came back with a form. He went over the entire pre-anesthesia care list and made sure I had no questions prior to the administration of the drugs. He admitted that he was giving me a little Versed and a little Fetanyl. I remember after the drug was delivered that I made fun of his name, and he said, "Yeah she's ready". I thought I was on my way to Sleepyville, but I then remember being in the OR and the nurse asking me if I had any questions before they began. I had enough consiousness to tell her to tell the surgeon that I wanted a flexible, string-like stent after the kidney surgery, so that I would not have to endure the horrific stent removal in the doctor's office.

The only time that I recall Versed possibly being used without being told they were using it was when I had to have my broken nose repaired. I'd been through surgery before, but not at this particular hospital. I was not sure what to expect. I remember that as soon as they wheeled me fron my room to the OR, I burst into tears. The doctor asked me if I was okay and I told him yes, I was just more nervous that I wanted to admit. He said it was OK and everything would be alright soon. The next thing I remember is waking up in the Post Op Unit. The surgery was over. I am positive that the Versed was administered, but since I was so freaked out about going into the OR, I am pretty happy that I don't remember it.

Anonymous said...

I have taken Versed twice, once for a wisdom tooth extraction and once for the removal of a lump on my breast. I think one major difference between me and a lot of the other people here regarding this drug is that I asked my provider many, many questions regarding my procedure and the drugs being administered. I was aware of how the drug worked as well as some of the adverse side effects such as the crying spells. Fortunately, I had no problems with the drug and was thankful it worked because although I am not squeamish about surgery itself, I don't want to remember oral surgery.

I empathize with those of you who have experienced this drugs effects without full knowledge of what they are taking. I also can see a flip side to this issue. I am an M2 med student so that might be some of where my bias is coming from, but I do feel that as responsible people we need to be in charge of our health. Some suggestions that I have for people who need any procedure is to get a second opinion, bring an advocate to help ask the questions you may not know to ask, and research, research, research!

Health advocates are people who know more about the medical community than the average person and are a great resource to find and use--and if a provider is offended with the advocate asking questions, then you know that you need to find a new provider. Of course there certainly are bad doctors everywhere in this world and I am sorry for those who have suffered at their hands. However, I also think that people are too trusting in doctors and believe they will tell them every little detail. We as patients need to be more responsible for our own health and and not be afraid to ask questions, research, use resources, and don't be naive--most doctors will only tell you the basics.

When buying a home or car, most people do their research. We ask the dealer about gas mileage, safety, and compare other vehicles. When buying a home we ask our agent questions, compare other homes, and have the house inspected. Yet more often than not, we don't use the same safeguards for own body. Bottom line: make sure to protect yourself!

JACKIE said...

We tried to be responsible and ask questions. Sometimes I feel like I am talking to a wall, the wall being medical people. As for "every little detail" I feel that amnesia and a zombie like cooperation with the medical people is far beyond a "little detail." In my instance this wasn't something that I could research (look at the glowing terms that Versed is described in by medical professionals; i.e. something to help you relax and "blissfully unaware" of what is happening to you)and even if I had known the name of this nasty drug Versed, how would I have known that they would call it by a euphamism or shoot me up with it after being specifically told that I did not want a debilitating drug and wanted to remain awake and alert! There was absolutely no discussion about their plan and how it deviated dramatically from what they had my permission to do. I had an acute medical trauma and was incapable of all of this research, and even with research, my team would have done as they damned well pleased regardless. They said so to my face, after the fact of course. You people can chide us all you want and blame us for not doing our "research," "trusting our doctor," not "hiring a patient advocate," (who knew that we would need an advocate just to get good care from the doctor?)not "questioning" enough, not knowing that we would have a severe reaction to the drug, ad nauseum. MEDICAL PROFESSIONALS WHO CARE MORE FOR DOLLARS AND FOR CHEMICALLY COERCING PATIENT COOPERATION ARE TO BLAME, NOT THE PATIENT. PLEASE, also remember that you are on a site for people who have suffered severe harm from being administered this drug. It is insulting to have you come on here and try to defend the indefensible! Versed is a very bad drug, with no way of knowing whose brain will react violently to this kind of assault. It is unknown how it works except that it completely disrupts the hippocampus and effects other regions of the brain in a negative way, (why else would the process be termed "agonizing" the GABAa receptors?) There is no known antidote to the lingering damage caused by its administration, and all you medical folks are in full DENIAL that there are ANY problems with your miracle drug.

Roger said...

I am an anaesthetist (anesthesiologist) working in Australia. I want to thank those of you who have posted your comments on this blog. I have found your comments very educational and it has certainly prompted me to provide a much more meaningful discussion with my patients before administering any sedatives in the future. I do a lot of obstetric anaesthesia and as such I am quite used to having patients wide awake (and often very anxious!) during their surgery (i.e. caesarean sections). It can be quite an art to reassure patients verbally and unfortunately not all anaesthetists may be very skillful or even comfortable at doing this. I suspect that most anaesthesiologists administer midazolam or other sedatives before you get taken into the OR not because of any malice but because of the well documented "anxiolysis" that these drugs usually provide, in the belief that most patients want this (in my experience most patients do). However this obviously not the case for all patients, they should treat you as individuals and actually ask. From reading your postings the amnesia that many of you experience is appears to be the main side effect that many of you dislike. My advice to anyone who does not want any amnesia is to communicate this clearly and assertively (but not aggressively) when you first meet the anaesthesiologist. If you do feel very anxious and "want something to settle the nerves" (either before or during surgery) I suggest that you request a short acting opioid like fentanyl (which like all drugs has it's own side effects, and problems) but very rarely causes any amnesia when used on its own.
I acknowledge that there may well be some anaesthetists or other health care professionals who use midazolam and other sedatives inappropriately......but I would like to hope that this is only a small minority.
Sedatives like midazolam should not be used as a substitute for adequate anaesthesia & analgesia (usually local anaesthetics & opioids).

Roger said...

I am an anaesthetist (anesthesiologist) working in Australia. I want to thank those of you who have posted your comments on this blog. I have found your comments very educational and it has certainly prompted me to provide a much more meaningful discussion with my patients before administering any sedatives in the future. I do a lot of obstetric anaesthesia and as such I am quite used to having patients wide awake (and often very anxious!) during their surgery (i.e. caesarean sections). It can be quite an art to reassure patients verbally and unfortunately not all anaesthetists may be very skillful or even comfortable at doing this. I suspect that most anaesthesiologists administer midazolam or other sedatives before you get taken into the OR not because of any malice but because of the well documented "anxiolysis" that these drugs usually provide, in the belief that most patients want this (in my experience most patients do). However this obviously not the case for all patients, they should treat you as individuals and actually ask. From reading your postings the amnesia that many of you experience is appears to be the main side effect that many of you dislike. My advice to anyone who does not want any amnesia is to communicate this clearly and assertively (but not aggressively) when you first meet the anaesthesiologist. If you do feel very anxious and "want something to settle the nerves" (either before or during surgery) I suggest that you request a short acting opioid like fentanyl (which like all drugs has it's own side effects, and problems) but very rarely causes any amnesia when used on its own.
I acknowledge that there may well be some anaesthetists or other health care professionals who use midazolam and other sedatives inappropriately......but I would like to hope that this is only a small minority.
Sedatives like midazolam should not be used as a substitute for adequate anaesthesia & analgesia (usually local anaesthetics & opioids).

Jackie said...

Thanks you Roger for your thoughtful post. I wish that the rest of these folks could have your empathy. I believe that some anxiety from patients would be a normal and appropriate reaction to surgery would it not? So why is it treated like it's the end of the world for a patient to feel anxiety? As for the amnesia, I didn't have it until they had given me 12 mls ( 2 mls in the preop and 10 more soon after I got into the OR) for a 70 minute extremity operation, along with the drugs Fentanyl, Benadryl, Propofol and Isoflurane. I felt SEVERE ANXIETY after they administered Versed, although I was incapable of expressing it! I couldn't figure out why I had a burning desire to obey them, why my body was flaccid and why I couldn't talk. It was very distressing and my blood pressure skyrocketed after they gave me this poison. I can't understand why you guys would feel that amnesia is the same thing as anxiolosis. I don't think that Versed relieves anxiety at all, it just prevents the patient from EXIBITING anxiety. Not quite the same thing. Combine that with amnesia and the patient (most anyway) can't TELL that they experienced anxiety, even though it seems that the repressed memory of the helpless anxiety is retained in some folks, and manifests itself in the symptoms that we describe in detail here. My problem is also with the extended anxiety well beyond the supposed after life of Versed, the feeling of being unsafe, the knowledge of being assaulted by people who were allegedly there to help me, the revulsion I feel when I hear certain words like "relax" and the phrase "I know what's best," the hatred of everybody who was involved with my "care," the bad dreams, insomnia, and the abject fear of being given this drug again. It really is an obsession that I believe was chemically induced by Versed. I think that Versed caused a chemical imbalance in my brain. Whether the brain over manufactures certain chemicals to combat the Versed or doesn't produce enough of certain chemicals after being given Versed is well outside of my meager expertise. I have read about drug addicts' brains discontinuing production of Dopamine after using opiods etc. and it is my contention that Versed also causes this kind of problem in many peoples' brains. Believe me, nobody is more astonished than I, that a single overdose (and by several accounts mine was an overdose) of Versed could cause me a myriad of emotional problems for over a year after the incident... I understand my loathing of the people who assaulted me with these drugs after I refused them, but what about the rest of it? I wish that I could have just ONE day go by without Versed problems popping up.

Anonymous said...

As a pharmacist with plenty of training in the area of IV drugs (and as someone in a primary care environment who interacts with patients post-procedure)..........with all due respect to the "anesthesia providers" who offer an opinion on Versed, let me make one comment: basically, Versed hurts a LOT of patients. The amnesia, PTSD that is causes is terrible and haunts many patients. When I have a procedure requiring an anxiolytic, a little fentanyl works great.....if I am unfortunate enough to require significany anesthesia (ie: induction, it will be with propofol)...and I have had: colonoscopy, umbilical hernia repair, knee scope and never needed anything beyond lots of fentanyl on demand ond local anesthesia...I would bite on a bullet before evey get midazolam...........your mileage may vary

Anonymous said...

let me be brief-Versed caused terrible amnesia and it isn;t just for the procedure....it's common for colonoscopy-skip the colonoscopy if your doc insists on versed...remember CRNA's are nurses, not doctors....if you want to protect your rights, just write "no versed or propofol" on the consent....write fentanyl only...this insures your right and you won't be a victim..........................when did amnesia become a part of medical practice?????????????????

SE said...
This comment has been removed by a blog administrator.
SE said...
This comment has been removed by a blog administrator.
Anonymous said...

As a Certified Registered Nurse Anesthetist (CRNA) who has been in practice for over 11 years, I would like to comment. The vast majority of people who I care for have a standard comment "I don't want to know, or remember anything." I personally don't administer versed to many of my patients because I think a good preop conversation with an anesthetist is effective in decreasing anxiety. If people still have anxiety and want something "to relax" I will give versed but it is the exception rahter than the rule. I have yet to have a case of intraoperative awareness in a very busy practice.
As a patient, if you want to be aware and have recall of the events surrounding your anesthetic and surgery or procedure that is your right. If so, you should make this clear to the people taking care of you, from the surgeon to the nurses in preop and anesthetist.
Versed or midazolam (the generic name) is a very effective and safe medication for relieving anxiety and decreasing recall of events. Most people want to "not remember" the operating room and preoperative experience. So if you are someone who doesn't want versed preop or in the operating room say so. You can always change your mind later and ask for something because are uncomfortable.
IF YOU CHOOSE NOT TO HAVE ANY SEDATION you should be aware that YOU ARE RESPONSIBLE for your memory and recall of events during the procedure (POST TRAUMATIC STRESS ISSUES) and you are responsible for remembering what may be an uncomfortable experience.
Certified Registered Nurse Anesthetists and Anesthesiologists want you to have a safe, positive, stress and pain free experience. As a patient you should discuss your concerns and expectations with all members of the healthcare team. We can then work with you to make sure that your experience is a positive one.

-Tim said...

Anonymous said:

"As a Certified Registered Nurse Anesthetist (CRNA) who has been in practice for over 11 years, I would like to comment. The vast majority of people who I care for have a standard comment 'I don't want to know, or remember anything.' "

Tim replies:

I don't believe that for a second after discussing this issue with a great many people, including most of the posters here. Most people are surprised to learn that drugs exist which allow a person to be conscious but not remember.

Anonymous said:

"I personally don't administer versed to many of my patients because I think a good preop conversation with an anesthetist is effective in decreasing anxiety. If people still have anxiety and want something "to relax" I will give versed but it is the exception rather than the rule. "

Tim replies:

From what we have seen, it is the rule and not the exception. One thing that burns me up is how my anesthesiologist worked very hard to deceive me even though my wife and I spent 10-15 minutes asking questions. Great lies of omission were committed. It is clear and obvious, in retrospect, that this person had an agenda and didn't want me to derail HER plans for my anesthesia. The amnesia aspect is exactly the kind of information I want up front, but this person worked very hard to hide this fact.

Anonymous said:

"As a patient, if you want to be aware and have recall of the events surrounding your anesthetic and surgery or procedure that is your right. If so, you should make this clear to the people taking care of you, from the surgeon to the nurses in preop and anesthetist.
Versed or midazolam (the generic name) is a very effective and safe medication for relieving anxiety and decreasing recall of events."

Tim replies:

The point I keep trying to get into you folks' thick heads is not so much that I am trying to recall events per se - the issue is that I don't want any drug induced amnesia. That seems to be the main effect of Versed. Furthermore, from what we have read from the posters here, Versed can actually INDUCE anxiety. The people who do recall often have very bad experiences.

Anonymous said:

"IF YOU CHOOSE NOT TO HAVE ANY SEDATION you should be aware that YOU ARE RESPONSIBLE for your memory and recall of events during the procedure (POST TRAUMATIC STRESS ISSUES) and you are responsible for remembering what may be an uncomfortable experience."

Tim replies:

This is more BS. The PTS issues come from the AMNESIA that has been forced upon us and, if you bothered to read the whole blog, there is evidence that, while conscious memories may be blocked by Versed, there is still residual subconscious trauma.

Obviously you folks think you can give people an amnesia drug and then treat the patient any way you damn well please.

Anonymous said:

"Certified Registered Nurse Anesthetists and Anesthesiologists want you to have a safe, positive, stress and pain free experience. As a patient you should discuss your concerns and expectations with all members of the healthcare team. We can then work with you to make sure that your experience is a positive one."

Tim replies:

Whatever. Frankly I think you are like most people. You don't give a damn about your job or your patients, you only think about yourself, and you want to hurry up and go home just like everyone else. The bitch who worked on me clearly didn't give a shit about me or any of my concerns.

Bryan said...

There is no excuse for rude or unprofessional healthcare providers. All competent patients should have a voice when it comes to there healthcare.

The purpose of Verced as one of the medications given during local with sedation, MAC, and general anesthesia, is to provide amnesia. Many lawsuits have been filed against anesthesia providers becouse of "recall" during surgery or a procedure. I have never heard of a law suit for someone not remembering their surgery.

Anesthesia by definition includes analgesia, amnesia, and muscle relaxation (paralysis) when required by the surgeon to perform the procedure.

Some procedures can be done under local only "straight local", with no sedation. This needs to be discussed with the surgeon before the surgery is scheduled to see if the procedure can be done under local only. And also to determine if the surgeon is willing to do it as such.

The key would appear to be better communication between the patient, surgion, and anesthesia.

I have given verced to my patients and received it as a patient myself. On both sides it proved to be a beneficial drug that performed its intended function of providing amnesia.

Jackie said...

If I could find anything amusing about this whole Versed thing it would be the inability of the medical people to admit that they are wrong. You people are wrong to administer this drug without proper and careful explanation of what you are trying to achieve. You are LYING when you say there is no time to explain it! Lying is WRONG! You sure have time to blather baby talk and euphamisms about it! (Relax you, my ASS!) You people are WRONG to say it is a safe and effective drug. You are WRONG to inimate that it is the patients' fault for WHATEVER specious reason that you come up with. You are WRONG in saying that MOST OR ALL patients desire to become amnestic zombies. You are WRONG WRONG WRONG! WE all know that it is your intention to deliberately and with malice inject Versed without ANY warning WHATSOEVER. The depth of your denial is absolutely INCREDIBLE! I also notice that not ONE of you has refuted my factual findings about the brain functions that Versed disrupts, and the resultant damage. I probably know more about it than you medical people and that's SCARY. But obviously facts and physiological brain changes have no bearing on your pathetic zeal to destroy patients' minds, so long as YOU like the outcome, screw the patient. By the way, the rage I exibit is an unwelcome change in my personality because of MIDAZOLAM. It's a good thing that previously I was pleasant or I might have become a psychotic menace after Versed. Think about that when you inject your next victim.

Anonymous said...

All I have to say is good luck with your next procedure, because it is probably going to be a very bad experience. Since, you don't believe what most healthcare professionals are trying to tell you, and you are going to be so worked up/stressed nothing short of general anesthesia is going to work for you.

jackie said...

Actually, my last experience was POSITIVE and I did not have ANY sedative, NOR was the general anesthetic required, as my first team claimed! Don't be absurd.

Anonymous said...

Here is the information Versed, at least if you are going to argue about something be well informed. Also, Versed is only one of many drugs that can provide amnesia effects.

Midazolam: Drug information

Copyright 1978-2006 Lexi-Comp, Inc. All rights reserved.


(For additional information see "Midazolam: Patient drug information" and see "Midazolam: Pediatric drug information")

PHARMACOLOGIC CATEGORY
Benzodiazepine

DOSING: ADULTS
Note: The dose of midazolam needs to be individualized based on the patient's age, underlying diseases, and concurrent medications. Decrease dose (by ~30%) if narcotics or other CNS depressants are administered concomitantly. Personnel and equipment needed for standard respiratory resuscitation should be immediately available during midazolam administration.

Preoperative sedation:
I.M.: 0.07-0.08 mg/kg 30-60 minutes prior to surgery/procedure; usual dose: 5 mg; Note: Reduce dose in patients with COPD, high-risk patients, patients 60 years of age, and patients receiving other narcotics or CNS depressants
I.V.: 0.02-0.04 mg/kg; repeat every 5 minutes as needed to desired effect or up to 0.1-0.2 mg/kg
Intranasal (not an approved route): 0.2 mg/kg (up to 0.4 mg/kg in some studies); administer 30-45 minutes prior to surgery/procedure

Conscious sedation: I.V.: Initial: 0.5-2 mg slow I.V. over at least 2 minutes; slowly titrate to effect by repeating doses every 2-3 minutes if needed; usual total dose: 2.5-5 mg; use decreased doses in elderly.
Healthy Adults <60 years:
Initial: Some patients respond to doses as low as 1 mg; no more than 2.5 mg should be administered over a period of 2 minutes. Additional doses of midazolam may be administered after a 2-minute waiting period and evaluation of sedation after each dose increment. A total dose >5 mg is generally not needed. If narcotics or other CNS depressants are administered concomitantly, the midazolam dose should be reduced by 30%. Refer to elderly dosing for patients 60 years, debilitated, or chronically ill.
Maintenance: 25% of dose used to reach sedative effect

Anesthesia: I.V.:
Induction:
Unpremedicated patients: 0.3-0.35 mg/kg (up to 0.6 mg/kg in resistant cases)
Premedicated patients: 0.15-0.35 mg/kg
Maintenance: 0.05-0.3 mg/kg as needed, or continuous infusion 0.25-1.5 mcg/kg/minute

Sedation in mechanically-ventilated patients: I.V. continuous infusion: 100 mg in 250 mL D5W or NS (if patient is fluid-restricted, may concentrate up to a maximum of 0.5 mg/mL); initial dose: 0.02-0.08 mg/kg (~1 mg to 5 mg in 70 kg adult) initially and either repeated at 5-15 minute intervals until adequate sedation is achieved or continuous infusion rates of 0.04-0.2 mg/kg/hour and titrate to reach desired level of sedation

DOSING: PEDIATRIC

(For additional information see "Midazolam: Pediatric drug information")
Notes: The dose of midazolam needs to be individualized based on the patient's age, underlying diseases, and concurrent medications. Decrease dose (by ~30%) if narcotics or other CNS depressants are administered concomitantly. Personnel and equipment needed for standard respiratory resuscitation should be immediately available during midazolam administration. Children <6 years may require higher doses and closer monitoring than older children; calculate dose on ideal body weight

Conscious sedation for procedures or preoperative sedation:
Oral: 0.25-0.5 mg/kg as a single dose preprocedure, up to a maximum of 20 mg; administer 30-40 minutes prior to procedure. Children <6 years, or less cooperative patients may require as much as 1 mg/kg as a single dose; 0.25 mg/kg may suffice for children 6-16 years of age.
Intranasal (not an approved route): 0.2 mg/kg (up to 0.4 mg/kg in some studies), administered 30-45 minutes prior to procedure
I.M.: 0.1-0.15 mg/kg 30-60 minutes before surgery or procedure; range 0.05-0.15 mg/kg; doses up to 0.5 mg/kg have been used in more anxious patients; maximum total dose: 10 mg
I.V.:
Infants <6 months: Limited information is available in nonintubated infants; dosing recommendations not clear; infants <6 months are at higher risk for airway obstruction and hypoventilation; titrate dose in small increments to desired effect; monitor carefully
Infants 6 months to Children 5 years: Initial: 0.05-0.1 mg/kg; titrate dose carefully; total dose of 0.6 mg/kg may be required; usual maximum total dose: 6 mg
Children 6-12 years: Initial: 0.025-0.05 mg/kg; titrate dose carefully; total doses of 0.4 mg/kg may be required; usual maximum total dose: 10 mg
Children 12-16 years: Dose as adults; usual maximum total dose: 10 mg

Conscious sedation during mechanical ventilation: I.V.: Children: Loading dose: 0.05-0.2 mg/kg, followed by initial continuous infusion: 1-2 mcg/kg/minute; titrate to the desired effect; usual range: 0.4-6 mcg/kg/minute

Status epilepticus refractory to standard therapy (unlabeled use): I.V.: Infants >2 months and Children: Loading dose: 0.15 mg/kg followed by a continuous infusion of 1 mcg/kg/minute; titrate dose upward every 5 minutes until clinical seizure activity is controlled; mean infusion rate required in 24 children was 2.3 mcg/kg/minute with a range of 1-18 mcg/kg/minute

DOSING: ELDERLY — The dose of midazolam needs to be individualized based on the patient's age, underlying diseases, and concurrent medications. Decrease dose (by ~30%) if narcotics or other CNS depressants are administered concomitantly. Personnel and equipment needed for standard respiratory resuscitation should be immediately available during midazolam administration.

I.V.: Conscious sedation: Initial: 0.5 mg slow I.V.; give no more than 1.5 mg in a 2-minute period. If additional titration is needed, give no more than 1 mg over 2 minutes, waiting another 2 or more minutes to evaluate sedative effect. A total dose >3.5 mg is rarely necessary.

DOSING: RENAL IMPAIRMENT
Hemodialysis: Supplemental dose is not necessary.

Peritoneal dialysis: Significant drug removal is unlikely based on physiochemical characteristics.

DOSAGE FORMS — Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Injection, solution: 1 mg/mL (2 mL, 5 mL, 10 mL); 5 mg/mL (1 mL, 2 mL, 5 mL, 10 mL) [contains benzyl alcohol 1%]

Injection, solution [preservative free]: 1 mg/mL (2 mL, 5 mL); 5 mg/mL (1 mL, 2 mL)

Syrup: 2 mg/mL (118 mL) [contains sodium benzoate; cherry flavor]

DOSAGE FORMS: CONCISE
Injection, solution: 1 mg/mL (2 mL, 5 mL, 10 mL); 5 mg/mL (1 mL, 2 mL, 5 mL, 10 mL)

Injection, solution [preservative free]: 1 mg/mL (2 mL, 5 mL); 5 mg/mL (1 mL, 2 mL)

Syrup: 2 mg/mL

GENERIC EQUIVALENT AVAILABLE — Yes

ADMINISTRATION
Intranasal: Administer using a 1 mL needleless syringe into the nostrils over 15 seconds; use the 5 mg/mL injection; 1/2 of the dose may be administered to each nostril

Oral: Do not mix with any liquid (such as grapefruit juice) prior to administration

Parenteral:
I.M.: Administer deep I.M. into large muscle.
I.V.: Administer by slow I.V. injection over at least 2-5 minutes at a concentration of 1-5 mg/mL or by I.V. infusion. Continuous infusions should be administered via an infusion pump.

COMPATIBILITY — Stable in D5NS, D5W, NS; incompatible with LR.

Y-site administration: Compatible: Alatrofloxacin, amikacin, amiodarone, atracurium, calcium gluconate, cefazolin, cefotaxime, cimetidine, ciprofloxacin, cisatracurium, clindamycin, digoxin, diltiazem, dopamine, epinephrine, erythromycin lactobionate, esmolol, etomidate, famotidine, fentanyl, fluconazole, gatifloxacin, gentamicin, haloperidol, heparin, hydromorphone, insulin (regular), ketanserin, labetalol, linezolid, lorazepam, methylprednisolone sodium succinate, metronidazole, milrinone, morphine, nicardipine, nitroglycerin, norepinephrine, pancuronium, piperacillin, potassium chloride, ranitidine, remifentanil, sodium nitroprusside, sufentanil, theophylline, tobramycin, vancomycin, vecuronium. Incompatible: Albumin, amphotericin B cholesteryl sulfate complex, ampicillin, bumetanide, butorphanol, ceftazidime, cefuroxime, clonidine, dexamethasone sodium succinate, floxacillin, foscarnet, fosphenytoin, furosemide, hydrocortisone sodium succinate, imipenem/cilastatin, methotrexate, nafcillin, omeprazole, sodium bicarbonate, thiopental, trimethoprim/sulfamethoxazole. Variable (consult detailed reference): Dobutamine, propofol.

Compatibility in syringe: Compatible: Alfentanil, atracurium, atropine, buprenorphine, butorphanol, chlorpromazine, cimetidine, diamorphine, diphenhydramine, droperidol, fentanyl, glycopyrrolate, hydromorphone, hydroxyzine, meperidine, metoclopramide, morphine, nalbuphine, ondansetron, promazine, promethazine, scopolamine, sufentanil, thiethylperazine, trimethobenzamide. Incompatible: Dimenhydrinate, pentobarbital, perphenazine, prochlorperazine edisylate, ranitidine.

Compatibility when admixed: Compatible: Hydromorphone.

USE — Preoperative sedation and provides conscious sedation prior to diagnostic or radiographic procedures; ICU sedation (continuous infusion); intravenous anesthesia (induction); intravenous anesthesia (maintenance)

USE - UNLABELED / INVESTIGATIONAL — Anxiety, status epilepticus

ADVERSE REACTIONS SIGNIFICANT — As reported in adults unless otherwise noted:

>10%: Respiratory: Decreased tidal volume and/or respiratory rate decrease, apnea (3% children)

1% to 10%:
Cardiovascular: Hypotension (3% children)
Central nervous system: Drowsiness (1%), oversedation, headache (1%), seizure-like activity (1% children)
Gastrointestinal: Nausea (3%), vomiting (3%)
Local: Pain and local reactions at injection site (4% I.M., 5% I.V.; severity less than diazepam)
Ocular: Nystagmus (1% children)
Respiratory: Cough (1%)
Miscellaneous: Physical and psychological dependence with prolonged use, hiccups (4%, 1% children), paradoxical reaction (2% children)

<1% (Limited to important or life-threatening): Agitation, amnesia, bigeminy, bronchospasm, emergence delirium, euphoria, hallucinations, laryngospasm, rash

CONTRAINDICATIONS — Hypersensitivity to midazolam or any component of the formulation, including benzyl alcohol (cross-sensitivity with other benzodiazepines may exist); parenteral form is not for intrathecal or epidural injection; narrow-angle glaucoma; concurrent use of potent inhibitors of CYP3A4 (amprenavir, atazanavir, or ritonavir); pregnancy

WARNINGS / PRECAUTIONS
Box warnings:

Benzyl alcohol: See "Dosage form specific issues" below.
Debilitated patients: See "Special populations" below.
Elderly: See "Special populations" below.
Respiratory depression: See "Concerns related to adverse effects" below.
Concerns related to adverse effects:

Anterograde amnesia: Benzodiazepines have been associated with anterograde amnesia.
CNS depression: May cause CNS depression, which may impair physical or mental abilities; patients must be cautioned about performing tasks which require mental alertness (eg, operating machinery or driving). A minimum of 1 day should elapse after midazolam administration before attempting these tasks.
Hypotension: May cause hypotension; hemodynamic events are more common in pediatric patients or patients with hemodynamic instability. Hypotension may occur more frequently in patients who have received opioid analgesics.
Paradoxical reactions: Paradoxical reactions, including hyperactive or aggressive behavior, have been reported with benzodiazepines, particularly in adolescent/pediatric or psychiatric patients.
Respiratory depression: [U.S. Boxed Warning]: May cause severe respiratory depression, respiratory arrest, or apnea. Use with extreme caution, particularly in noncritical care settings. Appropriate resuscitative equipment and qualified personnel must be available for administration and monitoring. Initial dosing must be cautiously titrated and individualized, particularly in elderly or debilitated patients, patients with hepatic impairment (including alcoholics), or in renal impairment, particularly if other CNS depressants (including opiates) are used concurrently.
Disease-related concerns:

Heart failure (HF): Use with caution in patients with HF.
Impaired gag reflux: Use with caution in patients with an impaired gag reflux.
Renal impairment: Use with caution in patients with renal impairment.
Respiratory disease: Use with caution in patients with respiratory disease.
Concurrent drug therapy issues:

CNS depressants/psychoactive medications: Use with caution in patients receiving other CNS depressants or psychoactive medication; effects with other sedative drugs or ethanol may be potentiated.
Special populations:

Debilitated patients: [U.S. Boxed Warning]: Initial doses in debilitated patients should be conservative; start at the lower end of dosing range.
Elderly: [U.S. Boxed Warning]: Initial doses in elderly should be conservative; start at the lower end of dosing range.
Fall risk: Use with extreme caution in patients who are at risk of falls; benzodiazepines have been associated with falls and traumatic injury.
Obese patients: Use with caution in obese patients; may have prolonged action when discontinued.
Dosage form specific issues:

Benzyl alcohol: [U.S. Boxed Warning]: Parenteral form contains benzyl alcohol; avoid rapid injection in neonates or prolonged infusions.
Other warnings/precautions:

Appropriate use: Does not have analgesic, antidepressant, or antipsychotic properties. Does not protect against increases in heart rate or blood pressure during intubation. Should not be used in shock, coma, or acute alcohol intoxication. Avoid intra-arterial administration or extravasation of parenteral formulation. Use during upper airway procedures may increase risk of hypoventilation. Prolonged responses have been noted following extended administration by continuous infusion (possibly due to metabolite accumulation) or in the presence of drugs which inhibit midazolam metabolism.
Withdrawal: Rebound or withdrawal symptoms may occur following abrupt discontinuation or large decreases in dose. Use caution when reducing dose or withdrawing therapy; decrease slowly and monitor for withdrawal symptoms. Flumazenil may cause withdrawal in patients receiving long-term benzodiazepine therapy.
RESTRICTIONS — C-IV

DRUG INTERACTIONS — Substrate of CYP2B6 (minor), 3A4 (major); Inhibits CYP2C8 (weak), 2C9 (weak), 3A4 (weak)

(For additional information: Launch Lexi-Interact™ Drug Interactions Program )

CNS depressants: Sedative effects and/or respiratory depression may be additive with CNS depressants; includes ethanol, barbiturates, opioid analgesics, and other sedative agents; monitor for increased effect. If narcotics or other CNS depressants are administered concomitantly, the midazolam dose should be reduced by 30% if <65 years of age, or by at least 50% if >65 years of age.

CYP3A4 inducers: CYP3A4 inducers may decrease the levels/effects of midazolam. Example inducers include aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins.

CYP3A4 inhibitors: May increase the levels/effects of midazolam. Example inhibitors include azole antifungals, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, isoniazid, nefazodone, nicardipine, propofol, protease inhibitors, quinidine, telithromycin, and verapamil.

Levodopa: Therapeutic effects may be diminished in some patients following the addition of a benzodiazepine; limited/inconsistent data

Oral contraceptives: May decrease the clearance of some benzodiazepines (those which undergo oxidative metabolism); monitor for increased benzodiazepine effect

Saquinavir: A 56% reduction in clearance and a doubling of midazolam's half-life were seen with concurrent administration with saquinavir.

Theophylline: May partially antagonize some of the effects of benzodiazepines; monitor for decreased response; may require higher doses for sedation

ETHANOL / NUTRITION / HERB INTERACTIONS
Ethanol: Avoid ethanol (may increase CNS depression).

Food: Grapefruit juice may increase serum concentrations of midazolam; avoid concurrent use with oral form.

Herb/Nutraceutical: Avoid concurrent use with St John's wort (may decrease midazolam levels, may increase CNS depression). Avoid concurrent use with valerian, kava kava, gotu kola (may increase CNS depression).

PREGNANCY RISK FACTOR — D (show table)

PREGNANCY IMPLICATIONS — Midazolam has been found to cross the placenta; not recommended for use during pregnancy.

LACTATION — Enters breast milk/not recommended (AAP rates "of concern")

DIETARY CONSIDERATIONS — Injection: Sodium content of 1 mL: 0.14 mEq

MONITORING PARAMETERS — Respiratory and cardiovascular status, blood pressure, blood pressure monitor required during I.V. administration

TOXICOLOGY / OVERDOSE COMPREHENSIVE — Symptoms include respiratory depression, hypotension, coma, stupor, confusion, and apnea. Treatment for benzodiazepine overdose is supportive. Rarely is mechanical ventilation required. Flumazenil has been shown to selectively block the binding of benzodiazepines to CNS receptors, resulting in a reversal of benzodiazepine-induced CNS depression. Respiratory reaction to hypoxia may not be restored.

CANADIAN BRAND NAMES — Apo-Midazolam®; Midazolam Injection

INTERNATIONAL BRAND NAMES — Apo-Midazolam (CA); Dalam (AR); Doricum (VE); Dormicum (AE, AN, AR, AT, BB, BD, BE, BF, BG, BH, BJ, BM, BS, BZ, CH, CI, CN, CO, CY, CZ, DE, DK, EC, EG, ES, ET, FI, GH, GM, GN, GR, GY, HK, HR, HU, ID, IQ, IR, JM, JO, KE, KR, KW, LB, LR, LY, MA, ML, MR, MU, MW, MX, NE, NG, NL, NO, OM, PH, PK, PL, PT, PY, QA, RU, SA, SC, SD, SE, SG, SL, SN, SR, SY, TH, TR, TT, TW, TZ, UG, UY, YE, ZA, ZM, ZW); Dormicum[inj.] (HR); Dormonid (BR, CL, PE); Fortanest (ID); Fulsed (IN, MY, PL); Hypnovel (AU, BE, CO, CR, DO, FR, GB, GT, HN, IE, MX, NI, NZ, PA, SV); Ipnovel (IT); Midanium (PL); Midazo (TW); Midazol (IL); Midazolam Injection (CA); Midazolam Torrex (PL); Midolam (IL); Sopodorm (PL); Versed (FR)

MECHANISM OF ACTION — Binds to stereospecific benzodiazepine receptors on the postsynaptic GABA neuron at several sites within the central nervous system, including the limbic system, reticular formation. Enhancement of the inhibitory effect of GABA on neuronal excitability results by increased neuronal membrane permeability to chloride ions. This shift in chloride ions results in hyperpolarization (a less excitable state) and stabilization.

PHARMACODYNAMICS / KINETICS
Onset of action: I.M.: Sedation: ~15 minutes; I.V.: 1-5 minutes
Peak effect: I.M.: 0.5-1 hour

Duration: I.M.: Up to 6 hours; Mean: 2 hours

Absorption: Oral: Rapid

Distribution: Vd: 0.8-2.5 L/kg; increased with congestive heart failure (CHF) and chronic renal failure

Protein binding: 95%

Metabolism: Extensively hepatic via CYP3A4

Bioavailability: Mean: 45%

Half-life elimination: 1-4 hours; prolonged with cirrhosis, congestive heart failure, obesity, and elderly

Excretion: Urine (as glucuronide conjugated metabolites); feces (~2% to 10%)



Use of UpToDate is subject to the Subscription and License Agreement.

REFERENCES
1. Abernathy, DR, Greenblatt, DJ. Drug Disposition in Obese Humans. An Update. Clin Pharmacokinet 1986; 11:199.
2. Adrian, ER. Intranasal Versed®: The Future of Pediatric Conscious Sedation. Pediatr Nurs 1994; 20:287.
3. Allonen, H, Ziegler, G, Klotz, U. Midazolam Kinetics. Clin Pharmacol Ther 1981; 30:653.
4. American Academy of Pediatrics Committee on Drugs. The Transfer of Drugs and Other Chemicals Into Human Milk. Pediatrics 2001; 108:776.
5. Arcos, J. Midazolam-Induced Ventricular Irritability. Anesthesiology 1987; 67:612.
6. Ashton, H. Guidelines for the Rational Use of Benzodiazepines. When and What to Use. Drugs 1994; 48:25.
7. Booker, PD, Beechey, A, Lloyd-Thomas, AR. Sedation of Children Requiring Artificial Ventilation Using an Infusion of Midazolam. Br J Anaesth 1986; 58:1104.
8. Burtin, P, Jacqz-Aigrain, E, Girard, P, et al. Population Pharmacokinetics of Midazolam in Neonates. Clin Pharmacol Ther 1994; 56(6 Pt 1):615.
9. Davis, PJ, Tome, JA, McGowan FX, Jr. Preanesthetic Medication With Intranasal Midazolam for Brief Surgical Procedures. Anesthesiology 1995; 82:2.
10. Doyle, WL, Perrin, L. Emergence Delirium in a Child Given Oral Midazolam for Conscious Sedation. Ann Emerg Med 1994; 24:1173.
11. Fraser, G. Intranasal Midazolam. Hosp Pharm 1992; 27:73.
12. Hughes, J, Gill, A, Leach, HJ, et al. A Prospective Study of the Adverse Effects of Midazolam on Withdrawal in Critically Ill Children. Acta Paediatr 1994; 83:1194.
13. Jacobi, J, Fraser, GL, Coursin, DB, et al. Clinical Practice Guidelines for the Sustained Use of Sedatives and Analgesics in the Critically Ill Adult. Crit Care Med 2002; 30(1):119-41. Available at: http://www.sccm.org/pdf/sedatives.pdf. Accessed August 2, 2003.
14. Jacqz-Algrain, E, Daoud, P, Burtin, P, et al. Placebo-Controlled Trial of Midazolam Sedation in Mechanically Ventilated Newborn Babies. Lancet 1994; 344:646.
15. Kanto, J, Aaltonen, L, Himberg, JJ, et al. Midazolam as an Intravenous Induction Agent in the Elderly: A Clinical and Pharmacokinetic Study. Anesth Analg 1986; 65:15.
16. Kupietzky, A, Houpt, MI. Midazolam: A Review of Its Use for Conscious Sedation of Children. Pediatr Dent 1993; 15:237.
17. Lugo, RA, Fishbein, M, Nahata, MC, et al. Complication of Intranasal Midazolam. Pediatrics 1993; 92:638.
18. Magny, JF, Zupan, V, Dehan, M, et al. Midazolam and Myoclonus in Neonate. Eur J Pediatr 1994; 153:389.
19. Malinovsky, JM, Populaire, C, Cozian, A, et al. Premedication With Midazolam in Children, Effect of Intranasal, Rectal and Oral Routes on Plasma Midazolam Concentrations. Anaesthesia 1995; 50:351.
20. Massanari, M, Novitsky, J, Reinstein, LJ. Paradoxical Reactions in Children Associated With Midazolam Use During Endoscopy. Clin Pediatr (Phila) 1997; 36:681.
21. McMullin, ST, Schaiff, RA, Dietzen, DJ. Stability of Midazolam Hydrochloride in Polyvinyl Chloride Bags Under Fluorescent Light. Am J Hosp Pharm 1995; 52(18), 2018-20.
22. Mokhlesi, B, Leikin, JB, Murray, P, et al. Adult Toxicology in Critical Care: Part II: Specific Poisonings. Chest 2003; 123:897.
23. Murray, MJ, De Ruyter, ML, Harrison, BA. Opioids & Benzodiazepines. Crit Care Clin 1995; 11:849.
24. Rita, L, Seleny, FL, Mazurek, A, et al. Intramuscular Midazolam for Pediatric Preanesthetic Sedation: A Double-Blind Controlled Study With Morphine. Anesthesiology 1985; 63:528.
25. Riva, J, Lejbusiewicz, G, Papa, M, et al. Oral Premedication With Midazolam in Paediatric Anaesthesia. Effects on Sedation and Gastric Contents. Paediatr Anaesth 1997; 7:191.
26. Rivera, R, Segnini, M, Baltodano, A, et al. Midazolam in the Treatment of Status Epilepticus in Children. Crit Care Med 1993; 21:991.
27. Servin, F, Enriquez, I, Fournet, M, et al. Pharmacokinetics of Midazolam Used as an Intravenous Induction Agent for Patients Over 80 Years of Age. Eur J Anaesthesiol 1987; 4:1.
28. Silvasi, DL, Rosen, DA, Rosen, KR. Continuous Intravenous Midazolam Infusion for Sedation in the Pediatric Intensive Care Unit. Anesth Analg 1988; 67:286.
29. Votey, SR, Bosse, GM, Bayer, MJ, et al. Flumazenil: A New Benzodiazepine Antagonist. Ann Emerg Med 1991; 20:181.
30. Zeltzer, LK, Altman, A, Cohen, D, et al. American Academy of Pediatrics Report of the Subcommittee on the Management of Pain Associated With Procedures in Children With Cancer. Pediatrics 1990; 86(5 Pt 2):826.

jackie said...

I know all of this. I want to read more technical information, not just dosages, interactions and sugar coated adverse events. How do you think I know that I was oversedated? I am aware that other drugs cause amnesia and if you had looked at the list of meds that I was given you would have seen some others. DUH! I want to know why 99% of patients are given this drug, including most of us here who didn't want it, declined it, or otherwise indicated that it would be unwelcome. Just knowing dosages is not really informative, except it once more proves that I was overdosed. Why is it that you guys are so resistant to the fact that Versed causes harm? I would like to see a copy of your "informed consent" as it pertains to "conscious sedation" to see if the effects of Versed are uniformly ommited. I would naturally expect amnesia from a GA, but this Versed thing is much different. I have had surgeries prior to the advent of the one size fits all drug Versed and have not sustained the prolonged problems I have experienced with Versed. Enlighten us!

Anonymous said...

Jackie, there are 30 articles listed as references to answer more technical questions. The reason Versed is used over other similar drugs more often is because of its' short duration compared to similar drugs. It is generally considered a safer drug compared to the alternatives. If there is a particular article or two that is listed that you want me to post let me know (they can be a little hard to get unless you actually go to a public library and download them there). Also, is there another drug that you would like to compare it to? I will be more than happy to post it on here for comparison.

jackie said...

I would like it if you went to askapatient.com too and see what kind of rating Versed gets. Then look through some of the other drugs' ratings. Askapatient gives a pretty fair representation of how patients feel about Versed, and compared to other drugs, the sheer volume of comments on Versed.

jackie said...

I have looked into lots of other drugs, Propofol is another drug which I was given and which I now decline. I have read that it could be responsible in part for the rage reaction, I believe you guys call it emergence delerium, that I had when I awoke from the Versed/GA. I took Zanax for a while years ago for sleep aid, but quit when I read how addictive it is, so obviously the benzodiazipine family is not the problem, just Versed. I also refuse Demerol, which causes me to hallucinate. If you want to contact me directly instead of clutter up Tim's web site (and cause him to delete us) I'm at jmurraytruckin at aol.com

Anonymous said...

Jackie, I haven't heard of emergence delirium with diprivan/propofol especially when used for surgery/anesthesia purposes ( I am currently studying diprivan right now). The one drug that is known for emergence delirium is Ketamine. Demerol is known for hallucinations especially when used long term. Each drug has its' place or they still wouldn't be in use. I personally like Versed (having given it, received it, and allowed it to be used on my one daughter). I will try to email you soon, but I am actually procrasting right now when I should be studying....

-Tim said...

Bryan:

I considered deleting this post since you misspelled "surgeon" and "Versed" (!!!).

It certainly gave me doubts.

Now - did you even READ this blog before you posted? The pharmacist who posted just days before you said

"Versed hurts a LOT of patients"

The very next poster correctly asks

"when did amnesia become a part of medical practice?"

I am going out on a limb here, but I don't think amnesia was in the desired list of anesthesia effects 25 years ago.

As far as recall during a procedure goes, this touches on one of the issues I have with Versed:
Having a bad experience blocked from my long term memory is not good enough. You should ensure that this does not occur in the first place. I would prefer to not have any memory blocking drugs and should I have some unpleasant awareness during a procedure, I would want to be able to REPORT it - NOT have it blocked from my memory.

-Tim said...

Anonymous:

I was outraged to learn after my hernia repair that plenty of people have had the same surgery under local.

I had two hand surgeries under local and it was fine. I would not change a thing.

Basically, I do not want anything on board that does not have to be there.

I know of at least one hospital that will set up a mirror so the patient can watch their knee replacement surgery! That's for me!

Trust me, I am not going to allow myself to suffer physically or mentally. We all get that some surgeries require the patient be put under.

Just respect my choice to use the minimal amount of drugs required to get the job done. Also, I have NO use for amnestic drugs. I have had plenty of procedures and ER visits in my lifetime and the only experience that even comes close to PTSD was after being tricked into having Versed - and the subsequent memory loss. It has been three years and I still boil over this.

The experience caused these *weird* anxiety attacks the likes of which I had never seen before.

That being said, I would like to point out that I am a believer in "suffer today, relax tomorrow" meaning that, for instance, I could have easily endured some discomfort during my hernia repair if it meant I would have no side effects later.

I have no doubt that any future surgery I have will turn out just fine as long as the doctors are competent and work *with* me instead of *against* me.

Anonymous said...

Hi! I had an attempted colonoscopy on Sept. 7, 2007 as I had turned 50. Was given 30 mg Valium and 7 mg Versed intravenously. Weigh only 117 lbs. Am female. The procedure had to be stopped due to pain. I guess I had a panic attack. Remember the drug burning like hell. I think I might have tried to wrench the IV out. Could this be the Valium or the Versed? For 9 days I had confusion, depression, and memory loss. Felt better yesterday for the first time. Went to the ER 2 days ago because I had a lump in my vein where the IV was put in. Had veinal phlebitis for over a wk. Hot compresses and aspirin didn't help. The ER doc said I could have the lump forever. The doc's receptionist said veinal problems from the med can last at least 2 months (Some said 1 yr.) Scary not knowing what happened in there. Having deja-vu like experiences of bits of conversation with the doc and nurses. Have PSTD. Never again! Want to schedule a post-procedure appt. but am afraid the doc either won't have time or won't tell me everything. Am refusing the barium enema to complete the procedure.

Denise said...

First of all I am sorry that many of you feel as though you had a bad experience because of Versed. Being an anesthesiologist myself, I pride myself in the fact that I will provide the safest and most effective anesthesia in order for my patient to get through his or her procedure. Have you ever seen a child scared to death, clinging to his mother prior to having a procedure done? Have you ever struggled with patients who are so claustrophobic that they can't even stand to have an oxygen mask placed on their face so they can be put to sleep? The person who had the bruises on her face and arms. Did she ever think that she may of had a difficult airway or may have been combative to the point of hurting herself? Yes, Versed does cause a form of amnesia. It does not cause "total" amnesia as some of you have implied. It does cause a sense of forgetfulness in regard to events during and after surgery. It does not "rob" one of ones memory. It is a drug that causes relaxation and gives relief of ones anxiety prior to a procedure. For those of you who want total involvement in your health care so be it! I'm all for that. Just tell your anesthesia provider that up front. Some of you may need to just admit that you are control freaks and can't stand not being in control. Another case in point is that some of you may have some underlying dysfunctional personality traits that do become unmasked by Versed's effects and this is what is causing your post procedure side effects. Half of you are probably on Zoloft or some other form of antidepressant or mood elevating drug. You people really do need to get a life! If you feel that Versed is given just to rush you through your procedure and get you out of the hospital, then why do you even bother to have anything done?

Mlgsings said...

Denise, did you read Kirt, Mary, and Tim's experiences on the main page of this blog? I know there are some pretty hostile and bitter posts here directed at medical professionals, but the big thing Kirt, Mary and Tim have in common is NO INFORMED CONSENT followed by forced treatment. They were not offered Versed with an explanation of what it's for and it's effects allowing the patients to choose whether they wanted it or not, the drug was PUSHED ON THEM. Essential info was omitted, their anesthesia providers were only interested in running the show THEIR WAY and these patients were patronized or even lied to afterward when they asked "What the H-E-!-! happened to me? Their providers were both unprofessional and unethical in their conduct.

In my opinion, adequate anesthesia/analgesia is the key to a positive experience undergoing a procedure, not artificially induced amnesia to hopefully but not with certainty CYA in case the patient hurts. That and a warm, reassuring bedside manner tempered with patience and a willingness to talk with (not at) and listen to the patient also goes a long way to putting a nervous patient at ease.

in a nutshell, what's needed in medical care is "better living through compassion" not "better living through chemistry."

Melodie

P.S. I have a blog too! Check it out at http://www.mom2momcentral.com/blog

Anonymous said...

Hi Denise,

Control freaks, eh? Actually I wonder if the problem is too many health care provider being control freaks. You cite frightened children and claustrophopic patients needing anxiety-controlling drug in order to get necessary medical care. Ok, I can understand that. But why is Versed used routinely for procedures such as colonoscopy? Are you aware that studies show the overwhelming majority of people who have a Versed-free colonoscopy indicate they would have the procedure performed drug-free again? And studies of colonoscopy started without drugs where over 80% are completed without drugs? And studies that indicate half of patients who receive sedation for colonscopy are dissatisfied with it?

And yet in light of these results, it is used as the 'standard of care' in the US for colonoscopies. Why?

You repeat the advice of many health care professionals who have posted here that better communication is needed between patients and doctors. Well my doctor never asked me if I felt anxious and wanted a drug to control it. My doctor never asked if it was my desire to have no memory of the procedure. My doctor never informed me of the study results i've cited above that indicate the large majority of patients tolerate this procedure without any sedation. And my doctor used ambiguous terms like 'relaxation' and 'sedation' instead of saying amnesia or lack of recall or no memory.

Why would a doctor routinely use Versed for colonoscopy given the information above? Projecting their own fears and anxieties on their patients? A need to incapacitate and 'control' patients? Just asking...

John

Kay said...

to John: "A need to incapacitate and 'control' patients?" You betcha!!

Kay said...

To Denise: You say, "It does not cause "total" amnesia as some of you have implied. It does cause a sense of forgetfulness in regard to events during and after surgery. It does not "rob" one of ones memory." Then why does my husband remember only two 10 second events from the time he was injected(or before)until the next day?

You say, "It is a drug that causes relaxation and gives relief of ones anxiety prior to a procedure." Then why, when my husband's chart indicated he was calm (he confirmed this to me), skin warm, dry and pink, BP and P normal was he drugged for anxiety???

You say, "If you feel that Versed is given just to rush you through your procedure and get you out of the hospital..." That is exactly what the nurse told me - "it's easier for the doctor". Conveniently for her that was after the fact.

-Tim said...

Denise said...

" The person who had the bruises on her face and arms. Did she ever think that she may of had a difficult airway or may have been combative to the point of hurting herself?"

Tim replies:

This is one of the problems with versed! Normal people freak out! It is a classic case of 'if it ain't broke, don't fix it!"

Denise said...

"Yes, Versed does cause a form of amnesia. It does not cause "total" amnesia as some of you have implied. It does cause a sense of forgetfulness in regard to events during and after surgery. It does not "rob" one of ones memory. It is a drug that causes relaxation and gives relief of ones anxiety prior to a procedure."

You are either a liar or an idiot. Versed typically causes a dense, total amnesia and in fact this is one of the reasons you people say you use it. I can personally attest to this. If you bothered to read the complaints here and on askapatient, you would KNOW that many people, far from having anxiety relieved, have bad experiences up to and including losing touch with reality.
Many people report a type of sleep paralysis experience. As far as the word "rob" is concerned, you are splitting semantic hairs. See if you disagree with this: 'Versed prevents the formation of long term memories'.

Denise said...

Some of you may need to just admit that you are control freaks and can't stand not being in control. Another case in point is that some of you may have some underlying dysfunctional personality traits that do become unmasked by Versed's effects and this is what is causing your post procedure side effects. Half of you are probably on Zoloft or some other form of antidepressant or mood elevating drug. You people really do need to get a life! If you feel that Versed is given just to rush you through your procedure and get you out of the hospital, then why do you even bother to have anything done?

Tim replies:

You're really reaching here, aren't you? OOOkay, let me bust these points one at a time:

I sincerely doubt that ANY of the complainants here are control freaks. You totally disregard the manner in which we were treated. The post just after yours, by Mlgsings, is an excellent summary. Your bit about "underlying dysfunctional personality traits" is a long shot at best, and if versed in fact "unmasks" these traits, then maybe the drug needs to be reconsidered?
Just what *is* your point about the Zoloft, etc. ? And just what are you trying to say with your final comment? There's not even any logic to that statement. If one feels that versed is used to rush people out of the hospital, then that's a red flag!

Question: how much stock do you own in the company that manufactures versed??

Ken said...

I was given Versed and Demoral for a colonoscopy and the only explination of the drugs was that I was going in for a 20 minute nap and would wake up in the recovery room in a hour. At one hour and three minutes I was put out of the hospital without even giving me time to recover from the drugs. I woke up at home sitting in a chair. I was given the drugs without any warning, and from that point I never saw anyone or talked to anyone until I was at home.
From the moment I arrived for the procecure both the nurse and then later the CRNA were both scrambling around in a mad rush even though I arrived 30 minutes sooner then my scheduled time. I was told that the Dr. got real mad at them if the patients weren't ready when he was, and the nurse said " they don't call him fast Eddie for nothing" (Dr. Edward Stah....r)
I wandered around for two days and nights in total confusion as to what happened to me and where I was at, I even thought maybe I was dead. I landed in the ER after having my first (of many to come) panic attacks and PTSD brought on by the Versed.
What I learned from this is that the nurses,CRNA's,anesthesiologists, and even the hospital are working for the Dr. not the patient. The Dr holds their careers and their future in his(or her) hands and when the Dr. says jump their only concern is how high and how far. How can we trust these people to take away our control, when they are out of control of themselves? I think this is one reason Versed is pushed so hard, as it allows the support people to keep the Dr. happy and not have to explain their actions to the patient. Amnesia covers up alot. As far as them being the patients advocate, I distrust these people even more then the Doctor.

Jackie said...

Control Freak is it? Just goes to show you how medical folks view us. Half of us are on drugs to start with? Typical blame the victim once again.
These statements are very indicative of the disdain with which we are viewed by the HIRED HELP. How 'bout it folks? Any of you using Zoloft BEFORE the Versed? I wasn't and I'm not now. And yes cupcake, I do like to be in control of myself, don't you? I don't drink, have NEVER blacked out, don't smoke pot, or do any other recreational drugs, because I like being under control. This is not a bad thing, except to megalomaniacs like you... I also like to be consulted before some idiot in a hospital, playing God, decides to kick me in the head with some nasty drug like Versed. Before anybody starts in about how Versed is in the Valium family, let me point out that taking a pill to calm your nerves is completely different from having your entire brain disconnected for the benefit of a human body TECHNICIAN! I guess, using anesthetists' logic, a poppy seed bagel is equivalent to mainlining heroin. Both will get you a drug test positive for opioids, so I guess that they must be the same... Same family. Lastly, most of us did have a life before we were assaulted and our brains' damaged by Versed. I had quite a nice life, thank you, until those MORONS gave me Versed. I still have my life, but it is very different now, trying to combat the residual effects of Versed. Why don't YOU get a life and quit trying to peddle your lies and insults here. It won't work darling! Honestly, insults in the face of all the suffering here! It boggles the mind.

Anonymous said...
This comment has been removed by a blog administrator.
-Tim said...

Ken:

Thanks for your post.

Go to www.ratemds.com and post a write up about your doctor.

Then send us the link!

Jackie said...

Boy Ken, you got the WORST drugs they could possibly have picked. Demerol is also on my list of things NOT to give me.

Anonymous said...

I'm having a colonoscopy this week and I want versed and lots of it. Most people don't have any problem with the drug and actually like it. From reading your blogs it appears that you have your mind made up about the medical profession and are not open to any type of rebuttal or defense. But, I'll try anyway. As an anesthesia provider, I do give versed. It is usually my habit to ask or at least let my patient know what I'm going to put in their IV. I also try to educate when I can about the possibility of amnesia or explain why they didn't remember this last time they had surgery. Any anesthesia provider will tell you that giving versed is never a guarantee of amnesia, as we also have to be aware of an issue on the other end of the spectrum... awareness under anesthesia. Versed is not given to make things easier for the doctor, and that nurse who said so doesn't have a clue about what she is talking about. I am my patients advocate, I would not do anything unethical or harmful to the patient in order to please the surgeon, and I think I can say this for most providers. Lastly, I wanted to add that the effects of the drugs given are synergistic, so its not just the versed causing the amnesia, its the combination of drugs that adds to it. For example, the versed for anxiety/relaxation, the narcotic for pain, and propofol, for example, for sedation or anesthesia induction. On last thing, in some of the blogs, it may actually not be the versed that caused the problem. You may have received another drug, such as reglan, that can cause a bad reaction, and blamed the versed instead. In one story a daughter freaked out after versed, but I noted she was also given decadron. Maybe the bolus of steroid didn't agree with her. Just something to think about.

Jackie said...

Dear anonymous, "I want Versed and lots of it." This is probably one of the few times I am going to say something this evil. I hope you get that "Versed and lots of it!" I hope they give you the 12 mls that I got and I hope that you suffer the same fate as the rest of us here! I am willing to accept that Propofol, which is known to cause a rage reaction upon awakening, might be partly to blame for my out of control response immediately after I "came to" in the hospital. However, my symptoms began the minute they put the Versed into my bloodstream. (there was nothing else given to me at that time) I was unable to properly respond to this, that's the nature of Versed, but believe me, I knew that the minute I woke up that they were going to HEAR ABOUT IT BIG TIME! Which is exactly what happened. Go and get that Versed, and if you have a really bad reaction to it and are crying while typing a note to us, we will be here for you. You might be one of the lucky ones who like it. PS I have noticed that people of only average intelligence do not mind this drug. Bright people who obviously process information differently HATE IT.

Anonymous said...

You people are rude and crazy.

Anonymous said...

I think it's rude to deliberately give people a drug which you KNOW they won't like... I think it's crazy to maintain that the drug is safe in the face of all the complaints.

-Tim said...

To the last Anonymous:

Your definitions of "rude" and "crazy" are right on the mark. Bravo!

To the Anonymous before that:

I understand that Jackie slammed you hard and you wanted to respond, but don't paint all of us Versed protesters with one brush.

They not only abused her with Versed, but they also screwed up her arm fix so bad that she had to go back and get it done right.

I edit out a lot of clutter on this blog, and I tend to delete flame wars, so I was tempted to kill this whole thread. If everyone would please focus your comments on versed I'd appreciate it.

jackie said...

Tim is right, if I seem disrespectful and rude I am modeling the treatment I got from the hospital staff. IF my team had explained that they were definately going to give me a GA against my will and that they were going to give me an amnestic drug so that I might not know if I had been given one and would be incapable of objecting, I would have politely declined, signed myself out AMA and found somebody else who would do things my way, which I did do the second time. If they had just told me that they were going to try to create amnesia, that would have been sufficient for me to leave! The drug they gave me to gain compliance was Versed and this drug caused some long-term problems that few in the medical community want to admit or address. There is NO drug that is completely free of side effects. The idea that Versed causes no harm at all, ever, is preposterous, especially to those of us who have received it and been harmed. To be constantly belittled, demeaned and besmirched because we had an adverse reaction to a brain insulting drug is pouring salt on the wound. I'm sorry if I hurt your feelings like mine have been hurt. It didn't help that my operation was sloppily done (like the anesthesia) and required a year and a half of panic attacks before I could force myself to have it rectified. Being nice didn't get me anywhere with my "team," all it got me was Versed.

Anonymous said...

Not all doctors are evil, bad, and melicious. What's REALLY scary is where the physician's recieve their information from...the pharmaceutical companies. Not one person on this blog has taken a chill pill and thought about the every angle. Yes, there are bad doctors out there who don't care about you and just want you to shut up and get on with it. On the other hand, the data in medical journals which the doctors read and trust are tainted by pharmaceutical companies. The majority of research documented in journals are funded by....you guessed it....pharmaceutical companies. Perhaps we need to think on a broader scope and force these companies making the medication to relinquish the facts not only to the doctors but also to the public. This is not to say that there are physicians out there who push drugs regardless and with hold information but I'm not sure they are the only ones to blame in this medical mess.

Anonymous said...

Hi Anon,

re your comment: "the data in medical journals which the doctors read and trust are tainted by pharmaceutical companies. The majority of research documented in journals are funded by....you guessed it....pharmaceutical companies. Perhaps we need to think on a broader scope and force these companies making the medication to relinquish the facts not only to the doctors but also to the public."

This sounds intuitively like it would be true but it just isn't the case. The journals are full of articles suggesting doctors are overusing these drugs. I've linked to a few in the past but since the links don't seem to work for some browsers, i'll paste the abstract of one below:

Abstract A prospective study of the necessity of sedation, or analgesia, or both in total colonoscopy was performed. The procedures were performed in the office on 212 consecutive, nonselected patients. Intravenous sedation was not started initially, and all procedures were begun without medication. If the patient developed significant discomfort or sharp pain, intravenous diazepam (Valium®, Roche, Nutley, NJ) or midazolam (Versed®, Roche, Nutley, NJ) was given. Total colonoscopy was successful in 201 (95 percent) patients. Of these procedures, 173 (82 percent) patients required no analgesia or sedation. In the remaining 39 (18 percent) patients, only small doses of Valium or Versed were necessary. There were 2 (1 percent) complications, but they were directly related to polypectomy (stalk bleeding, serosal burn) and not to the colonoscopy. Patient acceptance was high because most of the patients were able to leave the office immediately after the procedure and many (at least 82 percent) were able to return to work or resume normal activities that same day. Intravenous sedation is routinely used during total colonoscopy by most practitioners and is considered the standard of care in most communities. However, the need for sedation during total colonoscopy has never been proven and is probably not necessary in most cases. Furthermore, when sedation is necessary, most patients are probably overanesthetized. This is significant, as it may make total colonoscopy more accessible, less expensive, and safer.

So the question remains, what motivates these doctors to overuse these drugs?

John

jackie said...

Anonymous, you are exactly right about the big pharma companies extolling the virtues of Versed in particular, with the full complicity of the FDA. I too have read the positively glowing terms that Versed is described in and how welcome the amnesia is for the patient... However, when I complained, my hospital liason repeated the same phrases over and over about how I "don't want to remember the pain," to "just forget it and move on," etc. OBVIOUSLY she has had many many complaints about Versed. I find even this feeble attempt to placate me insulting. There shouldn't be any pain with the arsonal of pain meds available and it isn't up to her whether I want to remember it or not. John, here's my take on the REAL reason that so many (but not all, please keep in mind that I am speaking specifically of CRNA's who give 99% of their patients Versed) CRNA's like Versed so much. They are only glorified nurses and I am positive they get flack from anesthesiologists and other nurses for putting on airs. So they take it out on their patients. They enjoy turning strong minded people into gibbering idiots and they LOVE how the patient is then putty in their hands and obeys their every command. It must be pretty heady stuff to be able to impose your will on a patient and force them to be so submissive. Judging by the laughter and rude comments I got while sedated, it also must be really fun to watch the patient try to move and to make snide remarks RIGHT IN FRONT OF THE PATIENT, like the patient can really do anything about it! How delightful and naughty! It's all in fun and the patient won't remember it anyway, right... It's a power trip, pure and simple. They won't admit to this because it doesn't fit in with their inflated view of themselves as Florence Nightingale, but I'll bet money that this is the true reason they inject Versed and this is why they can't tell us why they give us this poison. What I don't get is why real Doctors would put up with this crap, or actually use it themselves. They must not give a damn about their patient either.

david said...

Interesting website. I am an anesthesiologist and I always try to be upfront and honest about the drugs I use. I'd say about 99% of people prefer to be unconscious as early as possible and remember as little as possible about their surgery, so we get used to sedating people as soon as possible. Unfortunately, this is not right for most posters on this website. I always offer a regional anesthetic for people that desire to be awake during surgery. In some cases this is not possible due to the nature of the surgery, and I inform the pt as such. In any case, a request to not receive Versed should be honored.

david said...

For those refusing Versed - As an anesthesiologist I can tell you that you may have to be very strong in your refusal. The idea that people actually don't want versed is foreign to a lot of health care workers, so they will want to give it anyway. We see the effects of versed many times every day, and I can tell you that nurses and doctors who administer Versed almost always want Versed when going through a procedure themselves. FYI - the easiest way to avoid Versed would be to list it in your medical allergies.

By the way, I have had versed administered to me without my knowledge, and it was a wonderful experience. I was in a Colorado ER after I had broken my leg snow skiing. I was in great pain at the time and reguested that my expensive ski boot be cut off instead of pulled off. I couldn't imagine the pain that would come with pulling that ski boot off. They informed me that they did not have a way to do that. I may have started crying at that point. Several minutes later (or perhaps an hour later, who knows?) I woke up from a sleep I don't remember entering and saw my boot across the room on a chair. I looked at my leg - the bott was gone! I couldn't believe it. I was so thankful.

One other thought, and this is not meant in a mean way or as an insult. The idea that Versed should be pulled from the market is a fringe idea that will not happen. Let's face it, this website is a fringe group. You are a very small group of people that are very far from the mainstream opinion when it comes to this topic. You have the right to refuse Versed and that should be honored. But, Versed is a wonderful and safe drug for most people.

john said...

Hi David,

Thanks for sharing your suggestions and personal experience. I'd appreciate getting your thoughts on a few questions:

How do you assess that "99% of people prefer to be unconscious as early as possible and remember as little as possible about their surgery"? Do you ask them? Do you evaluate their stress visually? Do they volunteer that information to you?

And also, on what basis do you believe that people who dislike Versed are "very small group of people that are very far from the mainstream opinion when it comes to this topic." Is this just your gut feeling or is it based on medical studies that evaluate patient satisfaction with the sedation drugs they have been given?

John

Mlgsings said...

To the last "anonymous" - in a general anesthesia case, you're going to be unconscious anyway for the procedure - nobody here is saying they want to remember that part or that they're against general anesthesia. Not everyone is freaked out at the sight of the operating room or people wearing masks or having to breathe from a mask until they go under. Some people actually prefer to have no more drugs than necessary to get the job done.

If I'm having a tooth filled, novocaine will be sufficient. I'm not going to be traumatized b/c I heard the sound of the drill or felt some vibration. If I have to have several teeth filled, though, I might want some nitrous as well to make me more comfortable. But I'm not a dentalphobe. Some people just totally panic at the thought of going to the dentist and will be traumatized just by a cleaning. Those people SHOULD be offered IV sedation. And they will most gladly accept.

If I was having a major surgical procedure like a total joint replacement or heart surgery or something, I'm pretty certain I would be going in pretty freaked out and would welcome receiving sedation. But if I'm having a colonoscopy just some demerol or fentanyl will be sufficient. I don't understand why such big-gun sedation is routinely administered for colonoscopy. It seems to me that for the most part the dread of the nature of the procedure ("You're putting that THERE?!") is worse than how it really feels. Sedation should be applied on a case-by-case basis as needed.

Jackie said...

I'm with John on this one too. I know a lot of people and very FEW of them want amnesia. It's one thing to be "loaded" and not care what's being done, it's another to be cozily chatting with people, cooperating and enduring (sometimes) unimaginable pain on the premis that if you can't remember it, it didn't happen. I don't believe that 99% of people can agree on ANYTHING even chocolate! I am generous when I say that MAYBE half of the patients would welcome amnesia. Also, Versed is causing some prolonged mental reactions, regardless if the patient agreed to Versed or not. It would be nice if you anesthesia folks would start listening to your patients' reports of this instead of finding other reasons for them to be having anxiety attacks etc. after being administered Versed.

Anonymous said...

You people are friggin idiots. What the heck is the point of anesthesia? So you don't remember the operation! I can't believe we have people who want to sue every anesthesia provider because they had recall (memory) of surgery, and now dorks like you complain that you DONT remember anything.

Anonymous said...

People sue for intra operative awareness, when they are supposed to be UNCONSCIOUS!!!!! Having a chemical amnesia which is unreliable at best is not UNCONSCIOUS!!!! Anesthesia does not equal amnesia! (Or at least it shouldn't)

Jackie said...

It's amazing to me that anesthetics are now only amnesia drugs according to our poster here... No wonder we don't need anesthesiologists any more. Amnesia has now taken the place of proper patient care and comfort as I have noted already. In the old days patients were anesthetized so that they felt no pain and were completely unconscious. Now with Versed, only the hoped for amnesia matters. This is a sad state of affairs for todays patient. I bet that the poster is a CRNA. If this person isn't a warning to anybody considering any kind of medical procedure I don't know what is. Amnesia is anesthesia, ohhh boy.

Jackie said...

I had to add this! "Anesthesiology, as defined by the American Society of Anesthesiologists (ASA) is defined as the practice of medicine dedicated to THE RELIEF OF PAIN and TOTAL care of the surgical patient before, during and after surgery." (emphasis is mine) Sound like Versed? Anything in it about amnesia? Nobody here complaining about Versed recieved TOTAL care from their anesthesia provider before during or after surgery.

Anonymous said...

Here's part of a post found on a dentists message board. I think it speaks for itself as to how Versed is viewed by the professional:

"Of course, there are two factors that force me to work slower: 1. the patient isn't under IV sedation (I give them a milligram of Xanax an hour before and nitrous), so I can't brutalize them the way most oral surgeons do when the patient is under sedation. I have to stop and ask if they're ok, and if they feel pain, I have to give more lido. Under sedation, you can typically keep going because they'll forget all about it."

Yep. Everyones worst fears confirmed.

david said...

John,

I copied your questions here so I could respond to them clearly.

1. How do you assess that "99% of people prefer to be unconscious as early as possible and remember as little as possible about their surgery"? Do you ask them? Do you evaluate their stress visually? Do they volunteer that information to you?"

I am an MD and I supervise CRNA's. I talk to all my patients before anesthesia and surgery, so I probably talk to 30 or 40 people a day about their anesthetic. Let's take the extremes. There are about 5-10 people a DAY that are very nervous about the procedure and want as little awareness as possible. They will say things like, "I don't want to know anything" or "knock me out NOW" or "why am I still awake?" It happens constantly. The other extreme is poeple who don't want to go to sleep, or would prefer as little sedation as possible. This happens about 3 or 4 times a YEAR. It's just very rare that someone comes in with the concerns mentioned on this board. Usually it's the opposite. As far as the 99% number. That's an extimate based on my 5 years of experience. No official study. One other tidbit . Sometimes it is beneficial to perform a regional anesthetic for a case and not have the patient asleep. It is almost always very difficult to talk a person into that type of procedure.

2. And also, on what basis do you believe that people who dislike Versed are "very small group of people that are very far from the mainstream opinion when it comes to this topic." Is this just your gut feeling or is it based on medical studies that evaluate patient satisfaction with the sedation drugs they have been given?

Again, no study. Just my experience talking. I talk with many patients the day following surgery, and complaints about Versed are extremely rare. The most frequent complaint would be a slow return to baseline, and this is usually for older patients that don't clear Versed very quickly. We know that Versed can have this effect, so we try to use it appropriately. Also, I think a positive testimony to Versed is that people sho see Versed in action (such as nurses) request it for themselves. If this was really a barbaric practice then I don't think people would request the same for themselves.

Thanks for the constructive questions.

david

david said...

Regarding amnesia as a part of anesthesia - We (anesthesia providers) are taught that amnesia is a part of anesthesia. We are taught very early that total anesthesia has 4 facets:

1. analgesia (pain relisf)
2. Unconsciousness
3. Muscle relaxation (basically being still enough for the surgeon to operate)
4. Amnesia.

You can quickly surmise that not all facets are necessary for every surgery. For example, a colonscopy only requires pain relief and being pretty still. Most people desire amnesia for this procedure, and most think they were unconscious afterwards.

Since several posters seem to mention colonscopies, I'll address those. Most colonscopies are performed under sedation given by an RN (not a CRNA) and supervised by the GI doc (not an anesthesiologist). This is generally referred to as "conscious sedation". Sometimes CRNA's and anesthesiologists provide sedation for older and sicker people, or people that have had trouble with "conscious sedation" before (this is called "monitored anesthesia care"). The GI doc and nurse are very limited in the druga they can use because of their training. We (anesthesia providers) have more drugs available and can usually provide a smoother sedation, however our drugs have a more dangerous side effect profile than Versed (such as apnea with propofol) that prevent the GI doc and RN from using them appropriately. So, as expected, our services come with increased cost that is not covered by insurance for most people. Insurance companies have a very strict list of what justifies "monitored anesthesia care" for a colonscopy, and we have to stick to this list.

As an aside, sedation for colonscopies, and most other procedures are smoother with propofol than versed, plus patients wake up quicker. For that reason, CRNA's and anesthesiologists usually prefer propofol over versed for short sedation cases such as colonscopies. My guess is that some of these unpleasant experiences were from an RN administering high doses of Versed under the GI doc's supervision, rather than from a CRNA's use of versed under an anesthesiologist's supervision. I'm sure that's not the case everytime, it's just a thought. Don't assume that just because you were sedated that anesthesia providers were involved. It may have just been an RN and the doc doing the procedure.

david

jackie said...

David, what do you do about your patients who wish not to have Versed, those four or five a year that don't want all the drugs? This is anonymous, so maybe you can tell us. Do you give them Versed anyway, because you think it's a good drug?

david said...

I would never give my patients a drug they are refusing. If a patient says they don't want versed I don't give it. For example, if a patient wants to be fully awake for their knee scope with a spinal anesthetic, that's fine with me. As a matter of fact, keeping people awake and performing a regional anesthetic, or "block", is often easier for us. That way we don't have to wake people up from a general anesthetic, which can be the most challenging part of the case (kinda like landing a plane). I would love to practice anesthesia that way more often, but VERY FEW people want to be awake for surgery. I occasionally do cases like that, but they are very rare. Sometimes a pregnant woman comes in needing a surgery that a regional technique is appropriate for. These patients are the most likely to take a regional anesthetic with no sedation because it is safest for the baby. And probably half of those pregnant women still can't do it without sedation even when they are told it is safer for their baby if they receive no sedation. They just can't take the idea of being operated on while awake even though the area is numb. I'm always amazed that a pregnant woman would put her fetus at even a small risk for a lifetime defect just because they can't mentally handle a stressful situation for a few minutes. Again, that happens very frequently after I have made sure the pt is well informed as to her options. Amazing.

Anonymous said...

Hi David,

Again, thanks for taking the time to share your thoughts. It is very much appreciated (at least by me). I hope you'll be willing to address some follow-up questions as well.

Again on the subject of the 99% who you feel want to be unconscious and have amnesia: You have addressed the medical phobics and the people who are very nervous and you indicate these might be as much as 25-33% of your patients. And then we have the other extreme that you see so infrequently we can ignore for this discussion. So we are left with approximately 67-75% who are not obviously nervous but which you seem to be including in the group that you feel wants to be unconscious and left with amnesia. Why would you believe this? In the absence of being visibly nervous are they expressing a desire for unconsciousness and amnesia? Or are your just presuming they would desire it? Honestly I'm a little skeptical since for every medical phobic I personally know, I am aware of an equal or great number that strongly desire the least amount of medical intervention necessary.

I curious about your comment, " My guess is that some of these unpleasant experiences were from an RN administering high doses of Versed under the GI doc's supervision, rather than from a CRNA's use of versed under an anesthesiologist's supervision." Why would a patient perceive this as unpleasant as opposed to receiving Versed from an anesthesiologist? Is there something about receiving high doses or receiving it from an RN that might add to a patient's dissatisfaction? Or were you merely attempting to defend CRNAs and anesthesiologists?

John

david said...

John,

I'll answer the second part first, since it is the easiest. I was trying to point out that CRNA's would be much less likely to use high doses of Versed than RN's. Some patients are resistant to Versed for various reasons. Some are easy to anticipate before the procedure, and others are not. If a patient is resistant to versed, and an RN is sedating the patient, they will just give more versed, because their drug arsenal is very limited. Some of the unpleasant experiences, such as a slow recovery to baseline, may be related to these higher doses of versed. If a CRNA or anesthesiologist is doing the case then we will augment with different drugs (drugs not available to the RN and GI doc)instead of giving a high dose of versed.

Am I just defending Anesthesiologists and CRNA's? Well, I am an anesthesiologist so you must consider the source when you read my posts. I was a chemical engineer before my medical training, so I generally try to be an objective problem solver. I'm sure my tendency is to defend myself.

david

david said...

John,

How do I know that the remainder of people want to be unconscious and amnestic? Well, with those folks I have a normal discussion about when they will fall asleep and wake up, then they respond positively, and we move on. I always ask patients if they have any questions. At that point a frequent response is, "Just make sure I'm out doc." It is very rare that somebody says, "Are you sure I have to go to sleep for this?" It happens, but it's rare. Take another example - cases under spinal anesthesia. I explain the spinal and then say, "you'll be so numb that we could do the surgery with you awake and alert if you like, but we usually sedate people so they fall asleep while we're operating." They almost always respond that they would like to be sedated. It's probably been at least a year since I had a patient take me up on my offer to do the case with a spinal and no sedation.

I'm not trying to say that you are crazy, or that your requests should be ignored. I was just pointing out that it is a very small minority of people that think the use of versed is barbaric and should be stopped. It's just a fact that sometimes very unpleasant things are necessary in this world, such as surgery, colonscopy, prolonged dental work, or removal of a ski boot. If we can have these things done to us without the emotional scars that come with the experience, then most people in society want it that way. However, I recognize that a small subset of the population (this board) considers a small period of amnesia worse that suffering through the actual procedure. All you have to do is convey that to your anesthesia provider and we will work with you.

david

Anonymous said...

David,

You wrote: "very unpleasant things...emotional scars...suffering through the actual procedure."

No wonder all your patients are begging for mind-numbing drugs - or so you imagine. Did you ever consider, even for a moment, that you are projecting your own fears and desires (for drugs) on your patients? That possibly these patients don't harbor the same fears and anxiety that you do?

I've posted links to studies of colonoscopy begun without medication and over 80% were completed without analgesia or sedation. And yet, sedation is considered the standard of care for this procedure and provided routinely. Why? I realize this isn't the surgical setting that you work in, but I suspect the widespread use of these drugs, even where studies demonstrate the overwhelming majority of patients tolerate the procedure fine without them, says something about the DESIRE of the doc/nurses to use them and not about the NEED of patients.

So is the situation, as you suggest, really that "most people in society want it that way" or most doctors want it that way?

John

Jackie said...

David, I would like to tell you that Versed caused a kind of hyper anxiety, that lasted for a months and almost completely incapacitated me. This is sooo not me... I couldn't eat, sleep, work, concentrate, crying, rage etc. Of course I was angry about the amnesia part, (the attempt at amnesia in my case) but you are missing the point. Doesn't it occur to you that we are describing some kind of chemical imbalance in our heads? Why would we be so obsessive over this drug? Kinda an overreaction to a little bit of amnesia wouldn't you agree? I didn't even get the amnesia and I am experiencing the same symptoms! You guys are acting like we are a bunch of babies with secrets or some other odd reason to object to amnesia. (other than the FACT that we didn't want this kind of drug) This drug has severe side effects in some people! Jeez I wish I could get a consultation with somebody to tell me how to "snap out of it," but it was chemically induced by an unknown etiology (having to do with the drug Midazolam) and NOBODY is looking into this! How frustrating do you think this is? Not only were we deliberately and arrogantly omitted from our own care, basically obliterated, but now we can't even get anybody to admit that this drug does actually have some long term side effects!

jackie said...

Not to side track anybody, but there is another amnesia drug being described in glowing terms as beneficial to forget certain unhappy experiences, it's called Propranol, and is used for hypertension. The Doctors noticed that it caused amnesia and memory retrieval problems in some patients and are now experimenting with it. If you don't like Versed, I would not suggest you get this drug either...

Cassy said...

I was getting ready for a D & C, I had lost a baby. The anesthesiologist was walking by and asked if I was nervous. I told him no as surgery doesn't bother me. He said he wouldn't recommend the Versed because it would make me more groggy afterward. Then I actually had a CRNA for my anesthesia not the anesthesiologist I had just talked to. She was preparing to give me the versed even though I was told not to take it. She said it helps the anesthesia to work better. I said, "You make your patients take it?" She said no I can't make you and then proceeded to give it to me anyway. Where is the logic in that? I didn't have a bad experience however I had a deep bruise on the left side of my butt that hurt really bad for days afterward. They would have had to be handling me very rough for that kind of bruise...

Anonymous said...

I have had the absolute opposite of most of you guys' experience. In 2005 I was in a car accident and had to have my arm pieced back together. Pre-op I was terrified and had the dry heaves - they gave me Versed and I was calm, able to answer questions, and remember everything up to the moment I was out from the anasthesia. SEcond surgery this year, to remove the plate and pins they put in, I had to beg the anaestesiologist for Versed to calm me. Medical professionals are assholes, anasthesiologist in particular it seems. He told me "I went to med school, not you" and refused it. I told him "I know my body and how frightened I am and I will dry heave without sedation. He finally gave in, lo and behold I was calm, lucid, and again remember still everything up to about 30 seconds after they put the "gas mask" on in the OR. I was able to move myself from the gurney to the table with no assistance. I think you guys are taking this a little too far - the experience depends on the person. I am having surgery in three days and the only thing keeping me from being utterly terrified to the point of vomiting is knowing when I get there I will be given something I know will calm me. I do agree, however, that medical professionals always use the "who has the medical degree" bs - we know our bodies better than they do, even with their degrees, and we need to fight for what we know our bodies need to make our experience as comfortable as possible.

christie said...

Funny (or not so funny actually...)
I went in today for a small issue with my eye, and I asked the doctor about other doctors ( I will go in for a vaginal hysterectomy soon), and I asked who he would trust in hospital X.
His answer; "Nobody, they are doctors! Do your homework, and before you go to the hospital WRITE down what you want and what not, make your doctor sign it, and bring several copies when you go into the hospital. Hand EVERYBODY a copy!" He said that way they wouldn't make your document dissapear AFTER they gave you Versed anyhow.
A young doctor who tells it like it is!
Thank you for this forum, I will refuse Versed!!!!
All the best to you, all people who suffered. You saved me from going through it!

Mlgsings said...

Christie, as a mom of 4 kidlets, 3 of which were born in the hospital, I would like to note that those of us wanting less intervention during labor and birth are told to write up a "birth plan", get the doc to sign it and keep it on file, and to also bring 2-3 extra copies to the hospital, to make sure our wishes are respected. Now we find out it's a good idea also to write up an "inpatient plan" or even an "outpatient surgery plan". I think it's ridiculous and a darned shame we have to do this in this modern era. Every time you go to the hospital or ER they want to know if you have an advance directive or living will re: whether to use extraordinary measures to keep you alive in the event of a medical catastrophe, but too many times they don't seem to give a darn about the quality of care you receive or your wishes/feelings otherwise.

Reminds me of a Pink Floyd song, "WELCOME TO THE MACHINE."

Anonymous said...

I posted earlier about an unpleasant experience with Versed. I recently had another outpatient surgery in which I discussed with the anesthesiologist about my bad experience with Versed. It was obvious they still intended to give me Versed - but tried to determine if I wanted to be 'more' aware or 'less aware'. It's like I had no other option other than Versed. They were very nice and I was too weak/intimidated/lazy to keep pressing for something other than Versed. I finally agreed to being 'more' under than the last time. They seemed very surprised that I remembered anything from my previous experience.

Anyway, I had a better experience this time. The anesthesiologist and the CRNA were very nice and I felt better that at least I got to tell them my preference and my fears of that shadowy half-awake state that I hated last time.

Plus, I had a better knowledge of what drug I was being given. They made me laugh and relaxed me and just kept telling me that they were going to give me good drugs. As soon as I 'woke up' my first question was whether or not I said anything and they laughed and said I snored through the whole thing. They finally did tell me that I was 'confused' at the end but wouldn't tell me what I said.

All in all - I did have a better experience this time around and I really liked the CRNA despite their insistence on Versed. I felt no pain and, so far, haven't felt that terrible anxiety afterward that I had the last time. Maybe because I had a little more knowledge this time and because the anesthesiologist at least listened to me. AND took great pains to address my concerns.

And were able to make me laugh about my 'control issues'. Yes, it is hard to be in the driver's seat when you are having surgery.

So, I'm reserving judgement on Versed. 1 bad experience and 1 good.

Anonymous said...

Over my objections this material was used on myself (in conjunction with propofol and fentanyl) for a 10 min procedure (cysto retrograde) which is commonly done in industrialized asian countries (e.g. South Korea)with nothing at all.

My life has been "absolute living hell" ever since! I am afflicted with significant POCD a year later, even though I have been on an intensive cognitive training program for more than 10 months. At this point it appears that this combination of drugs (in possible conjunction with contrast media used during the procedure) caused an undocumented life threatening event that resulted in significant organic brain damage to myself!

I HAVE SINCE LEARNED THAT THIS MATERIAL WAS USED AS A "TRUTH SERUM" TO GET MY SOCIAL SECUITY NUMBER, WHICH I HAD REFUSED TO GIVE TO THE HOSPITAL! I have no way of knowing what other sensitive information may have been compromised.

Jackie said...

Dear Anonymous, this is something which we have all been concerned about! We have one poster who had his heart stopped with this med and another whose wife suffered a brain hypoxia. This hypoxia sounds like what happened to you. None of us have any way of knowing exactly what information we gave during our Versed experience, but lots of people have reported unchecked babbling due to this very bad drug. Lots of us get Versed plus Propofol, which the medical folks seem to ignore when they talk about injecting Versed OR Propofol. Too many drugs targeting the same areas of the brain at the same time is also a problem it seems to me! It is horrifying to imagine that they gave you these drugs and then obtained information which you had no intention of divulging. Very upsetting. Then to have the lingering problems which the medical people flatly deny is enough to drive anybody crazy!

Ken said...

To anonymous 10/19/07
Your first experience with Versed must have not been that bad to ever allow them talk you into letting them use it on you a second time. I was fed that happy clouds crap about the drugs when I went in, and after the problems started and everything fell apart, these same wonderful people vanished from sight never to be seen or heard from again. I never was allowed to talk to anyone even to find out what happened to me. In the future after telling them of my past problems with these drugs, if anyone ever tries to push Versed or Demoral on me again I will consider that a threat on my life and they better be perpared for the fight of their life.

Anonymous said...

Ken,

My first experience was pretty bad - but I had no idea how to talk them out of it this time. Yeah - I fell for the 'happy clouds' crap. BUT when you're laying there in a hospital gown getting ready to be cut on and two of the people who are holding your life in their hands are pushing the 'happy clouds' - how do you fight it? After all - I'm just the stupid patient, right? How do you overcome that . . I'm the expert and I know what's best now don't you worry about it kinda thing??

Guess I need an immediate MRI to see if I still have a backbone.

Mlgsings said...

To anonymous w/2 experiences, one bad and one not so bad:

Yes, when you're already in the holding area in your gown you're vulnerable, but the key to getting treating with your wishes taken into consideration is to make sure you don't sign the consent until you've discussed your concerns with the anesthesia staff and they answered all questions to your satisfaction. No satisfaction, no consent, no surgery/procedure. If you can keep your spouse or whoever came to the hospital with you until you go in, they can also advocate for you.

I had a small hernia repair last month, it was done with local. Normally they use "twilight sedation" because it can still be uncomfortable, but I didn't want amnesia. Because I was concerned I might get versed whether I wanted it or not, I did not sign the consent for anesthesia until after I talked to both the anesthesiologist and the CRNA. Because I had questions, they let my hubby go to the holding area right outside the OR so we could discuss things. I was fortunate that the surgeon and the anesthesia guys were all perfectly okay to let me stay awake if that's what I wanted and could remain still. So then I signed the form.

As far as my medical care or my children's is concerned, I absolutely will not work with a doctor who is not up front or doesn't want to answer questions or explain things. I also will not go with a doc who wants to administer treatment or a procedure that I (based on my research) don't agree with. I respect dr's and their education and experience, but I also know they're just as human as I am and can make mistakes or be biased, so I do my research and choose carefully, and so far I've been fortunate enough to avoid the bad experiences that many others have encountered.

RP said...

I am a 3rd year law student, and I am writing a paper on this very subject. If anyone has a copy of their disclosure statement given to them by their doctors and is willing to send a copy to me, I would greatly appreciate it. You can e-mail me at:
melismasboreme@gmail.com
Thank you!

jackie said...

Here's how I got the staff NOT to use Versed. I went to the hospital for a pre surgery screen. I INSISTED on talking to the head OR nurse and outlined that Versed was a deal breaker and that UNDER NO CIRCUMSTANCES ( you must use these words) was I to receive it. I had a smile on my face and steel in my voice. Then I insisted that I talk to the anesthesia provider BEFORE I appeared for surgery. I went over it with him on the phone, explained my unhappy experience with Versed and insisted (while laughing at my vehemence so as not to completely alienate him) that I not receive Versed or Propofol or Demerol. Each of these drugs has mind altering and or amnesia effects. When I presented myself for surgery I wrote in huge block letters on my intake form that these particular drugs weren't to be used and that I only wanted a painkiller, i.e. Fentanyl ( and specifically not enough pain killer to knock me out, which might be a sneaky way to get you unconscious against your will) and ZERO sedatives. I also crossed out any references to "Doctor can decide" on the general consent forms lest my good ole Doc decide that he had a better idea. Otherwise I would not be having surgery. It worked. I was clear that the operation was not going to happen with Versed, so THEY had a choice; go with what I wanted or tell me and let me find somebody who would.

Anonymous said...
This comment has been removed by a blog administrator.
Anonymous said...

I am grateful to have found this blog.

I was administered VERSED without informed consent. I had repeatedly offered my medication database (too many meds to remember) in the pre-procedure area, and it was refused. I was never consulted or briefed by anyone, except that I was told as I shifted myself from the gurney to the table that "we're going to give you something so that you won't remember the procedure." By that time, I'd been waiting for 4 + hours, and had a DEMEROL drip that had begun sometime before that. I was too tired and too drugged to ask more about the "something."

A couple of days after the procedure -- CRAP (pun intended), it was just a colonoscopy -- the Outpatient Clinic called (the “new and improved” patient care technique) to see how I was doing. I told the representative "LOUSY" because I'd found myself at home sort of "coming to" after 5-10 minutes focusing on a particular color on my PC monitor, or a particular character such as a period or an asterisk.

I got a very condescending "You must not have taken YOUR medication properly." The next morning, I went to the clinic, and asked to speak to the nurse -- or whatever she was -- who'd told me "we're going to give you something...." I told her about the side effects and asked why VERSED had been administered in the first place. She said "It's in the protocol. You replied to the questions we needed to ask you -- you don't remember the pain."

That was my 3rd or 4th colonoscopy over a 20 year period. I'd experienced only minor discomfort -- never "pain." Three years earlier, I'd conversed with the doctor, looked at the scope-monitor, etc., asked questions about the instruments, etc.

Not long after the unethical, improper and illegal administration of the VERSED, I had a routine follow up and medication check with one of my physicians, who "happens" also to have a Ph.D. in pharmacology, and who is published in standard reference works. He told me they should NEVER have administered me VERSED, given the **obvious**, **predictable** interactions with my other medications -- the ones they'd REPEATEDLY refused to accept from me and review.

The adverse effects continued for eight weeks, as far as I know. The ONLY reason I didn't sue the hospital and the malefactors who did this to me, is that the Chief of Medicine at that time was a high school classmate and teammate of mine, and I'd known his wife (the sister of my brother's "Best Man"), for 44 years. I now have “NO VERSED” prominently displayed on my list of medications. My cardiologist knows about the issue, and understands. Earlier this week, he did a heart catheterization. I was kidding him, but DID what I’d promised, writing NO VERSED on a piece of paper adhesive tape, which I affixed to my forehead.

Now, I know that television writers use poetic license, and exaggerate a lot, but the only time I’ve heard of VERSED in the media was in the context of some sort of espionage story, in which VERSED was described as a paralytic, as well as amnesiac. Fine and dandy; but the so-called medical usage of VERSED borders on violating -- no, in my opinion, it DOES violate -- that part of the Hippocratic Oath “Do no harm.”

I believe mine will be Comment # 200. I've written this without reading any of them. I don't know if anyone has contemplated this, but I believe that the problems of {a} side-effects, {b} improper and unethical administration of VERSED warrants a Congressional investigation of both the manufacturer & the AMA's standards & practices. The medical community, or some percentage of its members who are unethical, seem to be playing fast and loose with VERSED, with the contemptuous attitude of "You won't remember."

Anonymous said...

#201 is an addendum to #200. Nowadays, I carry 2 copies of my medication chart, along with my own running commentary of my medical history. I offer it, and demand that the person acknowledge receipt of it by signature, date, and time.
--- Bill

Guido M said...

"Non lasci i bastardi li danno VERSED."

(DON'T LET THE BASTARDS GIVE YOU VERSED.)

«Oldest ‹Older   1 – 200 of 670   Newer› Newest»