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| No. 30 | 
May 10, 2009, 09:44 AM
 Re: Colonoscopy Drugs and alternatives
Its very telling to see posts like hypocaffeinemia! To have patients concerns dismissed as "anecdotal" and < 500 patients a week with a severe and long lasting reaction to having parts of their brain shut off dismissed as insignificant, is breathtaking in its total lack of concern... Hypocafeinemia also has a stand alone article demeaning and degrading patients who have this reaction as well. When does patient experience become fact? Only when it coincides with the nurses convenience? For anybody who wants to research this bad reaction to Versed, there are plenty of scientific web sites as well as your own access to patients and specific web sites for health care professionals only. Once again it seems that patients are responsible for finding out on their own what drugs are and how the brain responds to them! This should not be a necessity for patients. There is an absolutely first class article by VickiRN (staff) here at allnurses about patient ADVOCACY vs. a paternalistic view. This should be mandatory reading for anybody even considering nursing.
 | | Advertisement Sponsored Links | | | | No. 31 |
May 10, 2009, 10:12 AM
Re: Colonoscopy Drugs and alternatives
Ah yes, once again neveragain resurfaces to post on a thread involving midazolam.
You clearly have missed the point of my posts and have elected to deconstruct straw men instead.
Advocacy, for the record, is a two way street. Giving people false information about therapies via scare tactics and unsupported anecdotes (the plural of anecdote is not data) is what I and most others would consider being a bad advocate.
By the way, I'm still waiting on citations to claims you made earlier in this thread.
| | No. 32 |
May 10, 2009, 10:48 AM
Re: Colonoscopy Drugs and alternatives
Yes, I surface on Midazolam discussions. I am a patient advocate with personal experience with Midazolam. It is not false to tell patients that Midazolam causes AMNESIA! It isn't false to tell the patient that under Midazolam they will be unable to stop the procedure whether or not they get amnesia! It isn't false to say that this drug is given so that you will be obedient. If a patient wishes to remain "awake and alert" it is unethical to give them Midazolam. I guess I would be one of those "tin hat" people who feel that because of the abuse associated with Midazolam that it should be banned. While I agree that some people prefer not to have any memory of a medical event, I strongly feel that this should be up to the patient with FULL disclosure. (actually this is the law, not just a strong feeling) Respect is also a two way street. I respect the fact that medical professionals have superior knowledge of general patient care. This does not apply to ALL patients ALL the time. What I do not understand is the vitriol expressed towards those patients who desire or need something different than "I know what's best and you are going to get whatever I want" type care. It is anecdotal to say that Versed is a good drug. Good for whom? Specific patients with phobias? Prove that Midazolam is good. Prove that patients are not suffering from this drug. By your own statement <500 patients per year are having a bad experience with this drug. Extrapolate from that that many patients are not best served by Midazolam. Wouldn't it be better to let the PATIENT decide whether or not to have a drug like Midazolam? If they know ahead of time what the drug is and does and that some people claim to have some residual anxiety afterwards, then the patient wouldn't be complaining would they? Because they CHOSE to have this drug with full disclosure. That is respecting the patient and the patient experience. Isn't it odd that I can decline Demerol, Vicodin etc. without any problem, but when it comes to Versed I get this kind of response? I see that you are very young so it may be that life experiences haven't given you perspective. As for the "citations" you can find these yourself if you are interested in expanding your education.
| | No. 33 |
May 10, 2009, 10:56 AM
Updated
May 10, 2009 at 05:32 PM by Silverdragon102
Re: Colonoscopy Drugs and alternatives
I am skeptical your citations exist. If you'd like me to be a better patient advocate, you'd kindly provide them.
Burden of proof, friend. Burden of proof.
Speaking of burden of proof, you asked me to provide evidence "midazolam is good". By, "good", I take it you are referring to its efficacy. I believe this will be a good jumping off place for you to review: 1: Maslekar S, Gardiner A, Hughes M, Culbert B, Duthie GS. Randomized clinical
trial of Entonox versus midazolam-fentanyl sedation for colonoscopy. Br J Surg.
2009 Apr;96(4):361-8. PubMed PMID: 19283736.
2: Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P,
Margolis BD, Byrne DW, Ely EW, Rocha MG; SEDCOM (Safety and Efficacy of
Dexmedetomidine Compared With Midazolam) Study Group. Dexmedetomidine vs
midazolam for sedation of critically ill patients: a randomized trial. JAMA. 2009
Feb 4;301(5):489-99. Epub 2009 Feb 2. PubMed PMID: 19188334.
3: Morris MI. Posaconazole: a new oral antifungal agent with an expanded spectrum
of activity. Am J Health Syst Pharm. 2009 Feb 1;66(3):225-36. Review. PubMed
PMID: 19179636.
4: Xue FS, Liu HP, He N, Xu YC, Yang QY, Liao X, Xu XZ, Guo XL, Zhang YM.
Spray-as-you-go airway topical anesthesia in patients with a difficult airway: a
randomized, double-blind comparison of 2% and 4% lidocaine. Anesth Analg. 2009
Feb;108(2):536-43. PubMed PMID: 19151284.
5: Zier JL, Rivard PF, Krach LE, Wendorf HR. Effectiveness of sedation using
nitrous oxide compared with enteral midazolam for botulinum toxin A injections in
children. Dev Med Child Neurol. 2008 Nov;50(11):854-8. PubMed PMID: 19046178.
6: Tao J, Nunery W, Kresovsky S, Lister L, Mote T. Efficacy of fentanyl or
alfentanil in suppressing reflex sneezing after propofol sedation and periocular
injection. Ophthal Plast Reconstr Surg. 2008 Nov-Dec;24(6):465-7. PubMed PMID:
19033843.
| | No. 34 |
May 10, 2009, 11:26 AM
Re: Colonoscopy Drugs and alternatives
LOLOL Benzodiazepines Linked to Post-ICU Depression Here is just one. I didn't really want to get into a *war* of citations. I assume that you will pick apart any of the studies I bring up. You may also want to look at studies of brain activity in people with a high IQ. Their brains ARE different and this may be part of the problem with Versed. Just a thought, I am not a neuro Doc, but neither are you... Remember that Midazolam is highly favored by health care workers. Having a blindly obedient patient who can't question or stop the procedure, and USUALLY has amnesia is a huge draw. It is also very expensive to get "conscious sedation." There are other studies as well. Look how OLD some of the citations you give are! A lot of what you cite are studies comparing (Midazolam with drug X) or (Midazolam with drug Y.) This isn't really asking patients if they want to be medical zombies or not. They are also from the perspective of the practitioner not the patient. As Paindoc says, it's a matter of perpective. As with any drug there is a curve of efficacy. There are people who WANT the drug (sedation dentistry comes to mind) and people who don't want the drug or have a paradoxical or bizarre reaction to it. I am saying that Midazolam does cause these problems in at least some patients, with or without disclosure. (you seem to admit that) I am saying that this drug should be an OPTION with full disclosure, NOT be routinely administered without explanation and with disregard and disrespect for the patients rights, wishes and/or experience with anesthesia drugs. As more and more people have an anecdotal experience with this drug and talk about it, you will find that more and more patients exclude Versed. I really hope that you in particular hypocaffeinemia are actually on a quest for knowledge that will make you a better nurse and not just wanting to squabble with me.
| | No. 35 |
May 10, 2009, 11:46 AM
Re: Colonoscopy Drugs and alternatives Originally Posted by neveragain 
Your article (review) does not support what you think it supports.
Here's just one part: Compared with other ALI survivors, those with depression were more likely to have suffered greater severity of organ failure and to have received a daily dose of 75 mg or more of a benzodiazepine.
These patients were on a continuous benzodiazepine sedation drip of 75mg or more, daily. It does not identify the agent, but it was likely lorazepam or midazolam. This might be regional variation, but lorazepam is preferred in this neck of the woods for continuous sedation.
In addition, the patients were on this drip for days, weeks, even months.
Compare this to limited bolusing of typically less than 5-10 mg over thirty minutes or so during a procedure.
Even then, with long term heavy use, there was only a correlation in a small percentage of individuals- individuals with complex morbidities and treatment plans.
---
You are putting words in my mouth again regarding midazolam. I have no particular love affair with the drug. I selected propofol when I did my first scope, as it is a superior drug (one that requires a trained anesthesia expert, mind you).
I am simply attempting to combat blatant disinformation about it. Being a patient advocate. Go back and read some of the explicitly crazy things said about its use in this thread, for context.
| | No. 36 |
May 10, 2009, 01:48 PM
Updated
May 10, 2009 at 03:52 PM by sharrie
Re: Colonoscopy Drugs and alternatives
You're right, a caring, well qualified Dr makes all the difference. I was VERY lucky to have found two of them in the St Pete-Clearwater area that agreed to do this procedure without sedation and just a small amount of Demerol (which really didn't do anything....I didn't feel any different and could have driven myself home oth times.
This is NOT a painful procedure if done correctly and the physican takes his/her time. I talked to my Dr's during both exams and removal of a very large polyp that ended up be pre-cancerous...no pain at all, no bleeding either. I was scared out of my wits that they would force sedation on me for this, but thank god there stil are some Humane Doctors in this world that actually LISTEN to their patients and comply with their wishes. I told both Dr's if I can have dental work done w/o novocaine and give birth to two 9+ lb babies naturally with no drugs that I'm sure that the "c-word" would not be an issue for me....and it wasn't.
Don't be scared, just do it....I went due to unusual bleeding, and thank god I did. If I hadn't had that polyp removed and biopsied, I would have had colon cancer in the next few years. An ounce of prevention is certainly worth a pound of cure.
| | No. 37 |
May 10, 2009, 02:08 PM
Versed is the drug from HELL
I tell everyone I know to never, ever let anyone give them the drug Versed, it causes permanant memory/brain damage, causes severe anxiety attacks and I also tell them if they cave in and let the dr/anestiologist/dentist/nurse give them this drug....they will never know life as they know it now....This drug needs to be banned from use on people it's PURE EVIL. Originally Posted by hypocaffeinemia Your article (review) does not support what you think it supports.
Here's just one part:
These patients were on a continuous benzodiazepine sedation drip of 75mg or more, daily. It does not identify the agent, but it was likely lorazepam or midazolam. This might be regional variation, but lorazepam is preferred in this neck of the woods for continuous sedation.
In addition, the patients were on this drip for days, weeks, even months.
Compare this to limited bolusing of typically less than 5-10 mg over thirty minutes or so during a procedure.
Even then, with long term heavy use, there was only a correlation in a small percentage of individuals- individuals with complex morbidities and treatment plans.
---
You are putting words in my mouth again regarding midazolam. I have no particular love affair with the drug. I selected propofol when I did my first scope, as it is a superior drug (one that requires a trained anesthesia expert, mind you).
I am simply attempting to combat blatant disinformation about it. Being a patient advocate. Go back and read some of the explicitly crazy things said about its use in this thread, for context. | | No. 38 |
May 10, 2009, 02:42 PM
Re: Versed is the drug from HELL Originally Posted by serialmom12 I tell everyone I know to never, ever let anyone give them the drug Versed, it causes permanant memory/brain damage, causes severe anxiety attacks and I also tell them if they cave in and let the dr/anestiologist/dentist/nurse give them this drug....they will never know life as they know it now....This drug needs to be banned from use on people it's PURE EVIL.
Right on cue, serialmom12 proves my point.
Thanks.
| | No. 39 |
May 10, 2009, 03:09 PM
 Re: Colonoscopy Drugs and alternatives
yup proves a point that I'm right and you're wrong and totally full of yourself, must be nice.
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