Should I or shouldn't I...

I had 24 mlg of Versed in me a while back along with another drug (unkown), possibly a "pain-killer" of some sort before I was cardioverted due to atrial fibrillation. I wasn't out. So the fist shot of Joules caused me to clock the Cardiologist in the chin and scream out loud "OOOooch"! On the second one I sat up out of bed and hit the attending in the eye and screamed again.

I now hold the record at my local hospital for amount of Versed ever given. So, should I just make it easier on all and just tell the anesthesiologist on some upcoming outpatient surgeries I have planned that I am allergic to it or just tell them the story?


My way of thinking is that if I can take that amount of Versed at once, then the entire class of drugs in the same class as Versed won't work either. Right or wrong?

[sofmed]

Originally Posted by MAB32

So, should I just make it easier on all and just tell the anesthesiologist on some upcoming outpatient surgeries I have planned that I am allergic to it or just tell them the story?

I say just surprise 'em.

Cheers!

Mick

Mick,

I can't stop laughing! I would but I am afraid that I may get a few knock-outs in before they realize: "Hey, he shouldn't of been able to do that?" I really don't want to hurt anybody.

[sofmed]

I agree with you. I thought it was funny.

I have a friend who was under the knife for abdominal surgery several years back, and she came to on the table, broke one nurse's fingers and punched someone else in the face. Not exactly something I would expect happens all too often. At least I would hope not.

I made sure that I was OUT COLD for my two surgeries. Of course I'm a light weight so it doesn't take much.

It would definitely be better to tell them.

Mick

[RichL025]

All joking aside, TELL THEM.

I'd be pretty pissed off if I found out a patient of mine deliberately withheld a high versed tolerance (next time I would just cardiovert him without any )

[swatsurgeon]

Originally Posted by RichL025

All joking aside, TELL THEM.

I'd be pretty pissed off if I found out a patient of mine deliberately withheld a high versed tolerance (next time I would just cardiovert him without any )

Right on target with that reply...

my 2 cents:
MAB32, compromising your safety or the safety of a medical provider by withholding important information is comprable to patient 'malpractice' and falls under the catagory or negligence on the patient's part. It is the fastest way I know to be dismissed from a doctors practice, get labeled in your medical community so that no practicioner will take your case and you would not be a happy medical consumer.
It is attitudes and questions like yours that get my blood pressure up. Why would you question this issue....it makes no sense.

ss

[shr7]

I am confused as to why it is "easier on all" to tell them you are allergic? You are dealing with health professionals who usually have the capacity to understand. I wouldn't sell them short.

To answer your last question, I would say maybe, it depends. There are multiple reasons why you would need higher doses of Versed, some indicate that this effect would last across the class, some do not. For some background (I'm sorry, this is the only way I can feel relevant on this board...) Versed (midazolam) is in the benzodiazepine class of drugs. Other drugs you may have heard of that fit in this class are Valium, Ativan and Klonopin.

There are two major reasons I can think of for why this may happen. It could be a pharmacokinetic reason or a pharmacodynamic reason.

Pharmacokinetics means, what does the body do to the drug. Versed is metabolized in the liver by the CYP3A4 enzyme. The body oxidizes the drug so that it can be eliminated through the kidney. It is possible that you have a highly active 3A4 enzyme, in this case the body would eliminate the drug very quickly. Also, you could be on any number or drugs that induce the 3A4 system, decreasing your drug levels. These drugs range from certain antibiotics to steroids, to certain anti-seizure meds as well. A good medication history would have eliminated this cause, but there is not always someone around to check these interactions. Also Versed distributes to proteins and fat in the body, so if you have any "abnormalities" there, you may see a decreased effect. I guess my point is, if it is any of these reasons they can still use a different drug from the same class, because a lot of these properties are drug specific and not class specific. It may even be as simple as eliminating your caffeine intake that morning.

However

If it is a pharmacodynamic reason, you will not see any difference using other drugs of the same class. Pharmacodynamics is what the drug does to the body. Benzos facilitate the binding of an inhibitory neurotransmitter in your brain, which is why you see amnesia, anti-anxiolytic, and sedative effects. You could have a high tolerance to these drugs for many reasons. Alcohol, benzos and barbiturates all affect the same pathway in your body, so by chronically using one, you may set yourself up to be tolerant. It could also be just plain old genetics, maybe you are just not as sensitive to benzos as the next guy. So, if it is these reasons, you may not see any effect from switching drugs in the same class.

So, aside from justifying my choice to skip class today, why did I write this? I was just trying to illustrate the multitude of causes for a problem like yours. Your doctor would be aware of all of this information, and could probably do a detailed enough history to eliminate most of the causes. He/She could probably determine whether to switch drugs, switch classes, or even just know to start with higher doses. By telling them you are allergic, you completely shut off the door for any benzo use, under any circumstances, forcing physicians to use secondary options that may not be as good.

A patient who thinks for themselves is a good thing, but you need to understand your own limitations. Physicians are smart, they can handle the truth.

As a side note, ss, do you find Precedex (Dexmedetomidine) to be useful as an adjunct? Is it widely used, or is it still too new to have grabbed a foothold yet? I know there is concern over the CV side effects.

SR

[Red Flag 1]

if it worth saying, it will be quoted.

[swatsurgeon]

As a side note, ss, do you find Precedex (Dexmedetomidine) to be useful as an adjunct? Is it widely used, or is it still too new to have grabbed a foothold yet? I know there is concern over the CV side effects.

SR

SR,
Precedex... not for this case. We use it for flail chests, quick vent wean post op....good sedative effects without narcotic depression, but not for a small procedure like cardioversion.

back to versed....everyone is different and the kinetics of the drug will be different in everybody. Agreed it is NOT an allergy. Versed is a sedative/hypnotic. it usually does NOT knock you out...it does cause retrograde amnesia nut you are still able to interact with your world so you hitting/grabbing is not a surprise. The usual is to use different classes of drugs as combo to reach a desired effect. I also give 1-4 mg versed for a cardioversion and the patient is generally awake but has no 'evil' memory of what I just did to them. Do you have any idea how much of a benzodiazepine it takes to cause the body to shut down?? The pharmacy may have enough to be a lethal dose but overdosing sedates, you rarely if ever stop breathing...yes you can be rendered unconscious but not terminally so.

ss

I realize that I should tell the Doctor that I have a high tolerance to Versed. I am just sick and tired of telling these Doctors that I do have a high tolerance and they DO NOT believe me and in turn I remember everything including the pain!

SS,

you every been Cardioverted while awake? It is the worst pain you'll ever feel, not to mention the burn marks. So if I seem a little testy it is because of the fact that some Doctors out there do not take their patient seriously enough.

Also, when it comes to the Anesthesiologist asking me questions about my background I do not skip my Hx. I don't want to wake up on the OT and say or yell out loud "Oh Guys, I AM AWAKE !"

[Red Flag 1]

if it worth saying, it will be quoted.

[Red Flag 1]

worthless