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Old 06-12-2010, 08:14 AM
Mariette Deveau's Avatar
Mariette Deveau Mariette Deveau is offline
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Post Experiences with conscious IV SEDATION?

Have you ever had any medical or dental procedures done under conscious IV sedation before? -- more specifically, with the drugs Midazolam (aka Versed, Dormicum, Hypnovel) and Fentanyl (aka Sublimaze, Actiq, Durogesic, Duragesic, Fentora, Onsolis, Instanyl) ?

I'm having oral surgery later this week (five complicated molar extractions in one session). I don't need any advice, but I am interested in hearing other people's experiences with this type of sedation.


~M
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Old 06-12-2010, 12:25 PM
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Mariette Deveau Mariette Deveau is offline
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Re: Experiences with conscious IV SEDATION?

Why was the 'red cross' icon that I placed next to the title of this thread removed and replaced with another icon?
Does it represent something else other than a medical cross? Is it a religious icon?

EDIT: ooops! never mind. I just hovered my mouse over the red cross icon and noticed that it says "Charity Icon". My bad.



~M

{thank you}
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Old 06-12-2010, 12:43 PM
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Re: Experiences with conscious IV SEDATION?

I've had it five times with GI procedures and no problem. You will be groggy a good part of the day. They will no doubt have you come with another person, so they can drive you home. I don't know if in dental procedures they give you more of it or less. (maybe more, as they will work on you longer) I didn't remember a thing, one moment I was awake (it seemed) and the next I was waking up from it. No nausea. I even dosed off on the car ride home. (that's why you can't drive yourself) I don't know if this is any help?! Good luck!
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Old 06-12-2010, 02:27 PM
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Mariette Deveau Mariette Deveau is offline
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Re: Experiences with conscious IV SEDATION?

Thanks JR08.

Were you 'calm' beforehand? or anxious/scared? Do you know if yours also included the fentanyl?



And yes, I do have to have someone with me for 24 hours.
The versed will be administered gradually/slowly every 2 minutes, and if they notice that I'm in pain (example -- the 'freezing' wears off or doesn't work) they will add more fentanyl and/or increase the amount of versed.


~

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Old 06-12-2010, 02:44 PM
T.Wayne T.Wayne is offline
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Re: Experiences with conscious IV SEDATION?

I was IV sedated to get my wisdom taken out, they gave me versed and I honestly can't even remember anything about the experience not even the ride home. They gave me xanax to take before coming into the office which worked great. Versed will put you to sleep really fast, it's like a drug induced coma for like 30 minutes, that's how I would describe it.
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Old 06-12-2010, 02:50 PM
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Re: Experiences with conscious IV SEDATION?

Tyler,

They allowed you to take xanax the same day that you had the iv?

I would really like to take an ativan, or half of one, around two hours before going in, but the surgeon didn't seem to like the idea at all. He's probably afraid of overdosing or something... me going into respiratory arrest or respiratory depression, since they're both benzos AND it will be coupled with the fentanyl.

I dunno... I haven't made up my mind whether I'll pop one or not. I just can't imagine going there without taking one beforehand... I'll be a nervous wreck, I'm sure. If I do take one, I will tell him about it, of course.


~
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Old 06-12-2010, 05:58 PM
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Re: Experiences with conscious IV SEDATION?

I'd talk to them, I wouldn't take anything on my own. Tell them how anxious you are. I was the first time, and less the other times. I think they did give me something, but don't remember what.
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Old 06-12-2010, 06:59 PM
T.Wayne T.Wayne is offline
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Re: Experiences with conscious IV SEDATION?

Quote:
Originally Posted by Mariette Deveau
Tyler,

They allowed you to take xanax the same day that you had the iv?

I would really like to take an ativan, or half of one, around two hours before going in, but the surgeon didn't seem to like the idea at all. He's probably afraid of overdosing or something... me going into respiratory arrest or respiratory depression, since they're both benzos AND it will be coupled with the fentanyl.

I dunno... I haven't made up my mind whether I'll pop one or not. I just can't imagine going there without taking one beforehand... I'll be a nervous wreck, I'm sure. If I do take one, I will tell him about it, of course.


~

Oh yes, they allowed me to take it and in fact he wrote me a script to get them prior to surgery because I told him I was nervous about the surgery. Chances of OD in the hands of medical professionals is rare. They also have an antidote for benzos in case of an overdose, it's called Flumazenil and it works instantly. Benzos are really safe even in high doses. I actually had the xanax, painkillers, and versed in my system at the same time. They also have antidotes for opiate overdoses called naloxone. My sister told me overdoses are way overplayed (mostly a dramatic hollywood movie thing) and often don't need medical intervention.
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Old 06-12-2010, 07:11 PM
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Re: Experiences with conscious IV SEDATION?

Regarding the matter of taking an Ativan before my surgery: When I discussed it with him, even though he wasn't keen with the idea, he did end up telling me to take whatever medication I usually take but to make sure to tell him about it prior to the sedation. I think he would 'adjust' the amount of benzodiazepine in the IV accordingly, depending on how much I took and when I took it. If I do take any, it will just be .5 mg. That's a pretty low amount, just to take the edge off.

I'm afraid that if I go in there too freaked out, that it will increase my chances of having paradoxical reactions -- irritable, anxious, combative, etc... and that they won't be able to go through with the procedure, etc...


I wish I had a hypnotist that lived nearby so he/she could calm me down before I get there! LOL.


~
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Old 06-12-2010, 07:25 PM
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Re: Experiences with conscious IV SEDATION?

Quote:
Originally Posted by T.Ihrig
...

They also have an antidote for benzos in case of an overdose, it's called Flumazenil and it works instantly.

Ah yes, that's true. I forgot about that.


Quote:
Benzos are really safe even in high doses.
I've been taking them on and off since the 80's, and for a period of time was using them as a 'recreational drug', mixed with other drugs too, including alcohol. So I guess I am pretty tolerant of them.

An old friend of mine used to have a glass bowl of them on the dash of her van when we went to university together. We'd take them like if it was candy. It's a miracle we didn't kill anybody or ourselves. Thank goodness those days are over

Quote:
I actually had the xanax, painkillers, and versed in my system at the same time. They also have antidotes for opiate overdoses called naloxone. My sister told me overdoses are way overplayed (mostly a dramatic hollywood movie thing) and often don't need medical intervention.
I've done a lot of reading on different forums on the net, reading about different people's experiences with Versed/Fentanyl sedation & teeth extractions. I found that a great deal of them were very bad experiences.

So I'm glad to be reading (here) that you guys did not have any problems with with it.

I guess I'm trying to psych myself up that nothing bad will happen to me... that everything will go smooth.


The more postive experiences that I read about, the better I'll feel, I guess.


Thanks.

~
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Old 06-12-2010, 09:40 PM
T.Wayne T.Wayne is offline
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Re: Experiences with conscious IV SEDATION?

Quote:
Originally Posted by Mariette Deveau
Ah yes, that's true. I forgot about that.



I've been taking them on and off since the 80's, and for a period of time was using them as a 'recreational drug', mixed with other drugs too, including alcohol. So I guess I am pretty tolerant of them.

An old friend of mine used to have a glass bowl of them on the dash of her van when we went to university together. We'd take them like if it was candy. It's a miracle we didn't kill anybody or ourselves. Thank goodness those days are over


I've done a lot of reading on different forums on the net, reading about different people's experiences with Versed/Fentanyl sedation & teeth extractions. I found that a great deal of them were very bad experiences.

So I'm glad to be reading (here) that you guys did not have any problems with with it.

I guess I'm trying to psych myself up that nothing bad will happen to me... that everything will go smooth.


The more postive experiences that I read about, the better I'll feel, I guess.


Thanks.

~

Yeah, I've seen people at parties snort xanax and oxycontin and then drink a huge amount of alcohol then smoke pot and be just fine. I'm not saying I've done any of that though. Our bodies can sure take a lot of punishment that's for sure, were really resilient creatures. I'm sure you'll be just fine.
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Old 06-13-2010, 10:20 PM
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Re: Experiences with conscious IV SEDATION?

I've been through loads of different sedations from awake to twilight to being "out". One time I had a bad go of things and I really blame the doctor because it wasn't my first time being under nor my last.

When I've had dental work done I've been pretty zoned...even without a sedative beyond a local. I just make my brain go "to the beach". But for my very first time going under sedation? Yeah, I think I could have been given something before getting to the office...... I was a wreck.
Lately I've noticed a new awareness by medical staff to help avoid discomfort and really handle sedatives well.
Good Luck... buy ice cream the day before!
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Old 06-14-2010, 01:57 AM
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Re: Experiences with conscious IV SEDATION?

I had 3 wisdom teeth cut out when I was younger and I didn't feel a thing. I was sort of half awake but mostly out of it when they did it and it went fine. Good luck, hope it will go fast, painless and be over quick for you. I think the dreading it is the worst part!
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Old 06-14-2010, 11:46 AM
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Re: Experiences with conscious IV SEDATION?

When I've had this sort of thing done, I've been told that I'd be awake but drowsy. That's never been my experience....I go out like a light.

I've never been tense or nervous beforehand, which may be a factor.
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Old 06-15-2010, 01:18 PM
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Re: Experiences with conscious IV SEDATION?

I'll throw in my nickel's worth here, from both the surgeon and patient point of view.

I'm a retired podiatrist/foot surgeon (bailed on that profession after 8 years), and for most of my surgical cases, IV sedation with a local block was what I used. I wasn't administering it, of course, but the nurse anesthetist or anesthesiologist was, and I never had a single problem with any of my patients as far as adverse reactions or anything.

Versed is a rapid-onset benzodiazepine, and as others have said, is quite safe. It is not a sedative, per se, but is considered an "anxiolytic" medication, just like Valium, Ativan and others in the same class are. It also has mild amnestic properties (a good thing, since most people don't want to remember anything about the surgery ). This is in contrast to drugs like Seconal and sodium pentathol (not sure if that's even used anymore), which are both barbiturates and "hypnotics" - that is; they put the patient into a deeper state of unconsciousness: sleep.

Fentanyl is a narcotic-analgesic, also short-onset and short duration. It's used to help control pain that might occur during the surgery while the patient is sedated.

The other component of conscious sedation is Diprivan/propofol. This is a rapid-onset, short-acting hypnotic agent that is most commonly used for induction of anesthesia prior to general anesthesia (which is the deepest state of unconsciousness/hypnosis that can be obtained - pain is not felt at this level).

Diprivan is amazing stuff. I've watched as patients were totally awake and chatty on the OR table, having been already given some Versed, and when I was ready to give my local block (which is painful), I'd give the okay to the anesthesia person, and he or she would administer the Diprivan. It's a milky white liquid, so you can see it going through the IV tubing. Literally, within seconds of entering the patient's system, they go from awake to asleep and snoring sometimes. No fading out - just *snap*, and they are out! That was when I (or your dentist/oral surgeon) would give the local block. Patients still feel some pain, but they have no memory of it. So, it's awesome from that standpoint. If the patient didn't mind being awake throughout the procedure, the anesthesiologist wouldn't administer any more Diprivan, and the patient would wake up after maybe a couple of minutes or two. Otherwise, the MD or NA would keep them titrated with the Diprivan throughout the procedure.

I never had a patient say that their experience having surgery was bad or unpleasant. Part of that was because I used surgery centers vs. huge, impersonal hospitals, and patients are also customers and their well-being is important to everyone.

As far as my own experiences with surgeries and anesthesia, I've only had 3. First I was given valium and had a local block. The valium did an excellent job of taking the anxiety edge off, but I definitely felt the pain from the local block, which, based on the location, was hideous. Second was having two wisdom teeth extracted when I was in medical school. I didn't want general anesthesia, so went with nitrous oxide and a local block. I was so hugely anxious before this procedure; it was the first time I'd *ever* had any type of surgery. Once the nitrous kicked in, I didn't give a darn about anything - that was the coolest stuff EVER! However, it didn't stop me from feeling the pain of the local shots.

The only time I've had true conscious IV sedation was about 2 1/2 years ago for a minor gyno thing, but because of my inability to tolerate pain or discomfort in that capacity, and not wanting to have any memory of it at all, I went with IV sedation.

So, I got the Versed/Fentanyl before anything started. I wasn't remotely nervous about the procedure, having seen and participated in literally hundreds of various surgeries in the 11 years of residency and practice. It had essentially worn off by the time they finally brought me into the OR. The MD administered the diprivan and all I remember is feeling it burn a bit and then - nothing. Absolutely nothing. Just an inky blackness and no awareness of time passing, and no dreams. When I woke up in recovery, it seemed like just seconds later. To that end, it was awesome.

However, just a side note about the "amnestic" properties I mentioned...this can be disconcerting from a patient standpoint and certainly less than desirable from a doctor's standpoint, and that is that after the surgery, patients (including myself, apparently) can be awake, but have latent amnesia. They can talk, answer questions, etc. Later, though, they won't remember the conversation...or anything you as the doctor told them !

I had one patient that said to me right before her surgery, and after the initial diprivan dose had worn off: "Dr. Johnson, you aren't going to cut my toe off, are you?", which made me bust up laughing. Later, when I mentioned it, she did not have any memory of saying it, and was absolutely mortified and apologetic that she'd questioned anything I was doing. I told her that sometimes patients say funny stuff like this when they've been given these meds, and that I wasn't offended or bothered in the slightest [but was amused]. Or, carry on seemingly lucid conversations during the surgery with the surgery team about random subjects and not remember a thing later.

So, it's possible you might be chatty like that . No one will find it weird. I wondered if I said anything absurd or embarrassing during my last surgery. I do know that after the surgery, my doctor came and talked to me about it and I don't remember a thing, or seeing her; she was long gone by the time I remember anything. Knowing this was probably going to be the case, I always called my patients the same evening of their surgery to tell them directly how their surgery went. That was another thing everyone greatly appreciated. My doctor couldn't be bothered to do that, and I never went back.

I hope this long-winded reply has helped you a bit, Mariette. Modern anesthesia is incredibly safe and has a very low risk of side-effects, esp. the IV/conscious sedation. I say: "go for it!" Once it's over, you'll probably be amazed at what a non-event your surgery was . I'd never hesitate to have any surgery, even general, due to concerns about anesthesia.

Cheers,
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