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Anesthesia

Versed - the drug no one wants....

11/02/2006

Question:

Sorry, Doc, but I agree with the one query about being knocked out from versed....you remember nothing after any test - even being wheel-chaired out to the car. And you recall very little the entire day, even though you can answer a phone and respond. All my hubby did was sleep for 10-12 hours and was not lucid until the next day.

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.

Answer:

I respect your opinion but I believe your observations put you firmly in the minority. Clearly there are a number of people who do have such problems postoperatively, and in some cases a benzodiazepine, whether Versed (midazolam), lorazepam, diazepam or other drug, might be implicated. However, most patients who have received a benzodiazepine do not seem to have significant problems with prolonged confusion, unacceptable memory loss, or cognitive problems. I don't believe this has been systematically studied but it certainly seems like something worth study given the number of strongly expressed anecdotal opinions on this matter that I have received.

Part of the problem may be a mismatch of goals and expectations - anesthesiologists for the most part believe that their patients do not want to recall the surgical procedure, but a minority of patients do. What is needed is better communication. And that communication needs to happen, ideally before the procedure, in calm quiet surroundings. Preoperative clinics help. So do preoperative phone calls in which concerns can be discussed.

Another problem is that patients who are averse to midazolam want analgesia without sedation. This may be difficult to accomplish. Analgesic (pain-killer) drugs have their own problems including nausea and depression of breathing.

Finally, in our hospital, the PACU nurses are proud professionals with their patient's best interests at heart. They do not like taking care of "zombies" from a Halloween parade of ghouls.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University