questions on versed usage

Pediatric Critical Care Columnist · Jan 8, 2009

There are other drugs used in conjunction with the Versed (midazolam) that are analgesics or general anaesthetics. Ketalar (ketamine) is one that at high doses is both an anaesthetic and an analgesic. There are some concerning side effects with ketamine in older children and adults if not admnistered in conjunction with a benzodiazepine though so it's often given with Versed or Ativan. Fentanyl and sufentanil are both used frequently in the OR for procedural analgesia. My son's dentist uses a cocktail of fentanyl, midazolam and propofol (Diprivan) to sedate him for his dental work and it's great!

flightnurse2b, LPN · Jan 8, 2009

i have just read an interesting account on the internet concerning the use of versed, either alone for conscious sedation, or in conjunction with other anasthesias for surgical procedures. the article mentioned that versed was an amnesiac which when used erased any and all memories of the performed procedure. i have had versed used in four colonoscopies, and found this to be true. i remember being given an IV beforehand and being wheeled to the procedure room. the next conscious thought i had was waking up and being told everything was over. to this day that is all i remember about any of them. from someone who had told the nurse "i do not want to even see the operating table" before my cardiac bypass surgery in 1995, was just what i wanted to hear. i have learned since however, that while an amnesiac, versed has no analgesic properties. so my question is-----in a procedure such as a colonoscopy, does the patient actually feel the pain and discomfort involved and simply not remember it? thank you very much.

in my unit, we used versed in conjuction with a pain medication--either sublimaze or demerol. we have few complaints. i personally have never had a colonoscopy, i have had a bronch with the same meds and do have a few memories of waking up and feeling like i couldn't breathe during the procedure, but was very sleepy and comfortable afterwards.

however, i think sometimes physicians rely too heavily on the versed's amnestic property and think that the pts will not remember anything.... nowadays, people take many things that can impede their ability to be properly sedated for the procedure such as hypnotics, antidepressants and anxiolytics, or even just ETOH, so you can give them 5-10mg IV versed and they are still wide awake and have memories of the procedure.

i guess the thing to remember about having concious sedation is that yes, you are concious. you still have the possibility of feeling discomfort... even if an IV analgesic is used, it will help change the perception of pain being present, but many people will complain of pressure, bloating, cramping, gas pain, etc, yet due to the versed, don't remember any of it. i've had a patient come up off the table, smack me in the head, pull his IV out, and then finally dozed off... and when he got up was like "wow that was great i didn't feel a thing" and i would never tell a patient how they behaved while sedated.. i think it's inappropriate.

i hope that helps answer your question.... :)

racing-mom4, BSN, RN · Jan 8, 2009

If we are doing a bedside procedure that can be painful we use versed and morphine. We had one pt recently who was getting a major dressing change done Q12 that involved scraping and pulling ( I have tried to block the details from my mind!!) she had been getting the versed twice a day for about 8 days when she told me she was starting to see Tigers coming through the window-"but they were friendly tigers!!" We backed off on the Versed...

Pepperlady · Jan 8, 2009

We frequently use Versed and Fentanyl together. My last patient cried out during the procedure but 10 minutes later did not recall anything other than me talking to him as he went to sleep.

I had a young man propose to his girlfriend while he was under .... have always wondered how that went.

pinkdakota8 · Jan 8, 2009

I work in the cardiac cath lab ... for sedation we use versed along with fentanyl ... the combination of these meds works well for comfort and sedation... lidocaine is used for numbing the area... patients usually feel a pinch and that is it !

CHATSDALE · Jan 8, 2009

procedures that benefit from versed+analgesic/anaesthetics are a trauma to the body but the patient certainly benefit by not ungoing the pain and discomfort

sissiesmama, ASN, RN · Jan 8, 2009

in my unit, we used versed in conjuction with a pain medication--either sublimaze or demerol. we have few complaints. i personally have never had a colonoscopy, i have had a bronch with the same meds and do have a few memories of waking up and feeling like i couldn't breathe during the procedure, but was very sleepy and comfortable afterwards.
however, i think sometimes physicians rely too heavily on the versed's amnestic property and think that the pts will not remember anything.... nowadays, people take many things that can impede their ability to be properly sedated for the procedure such as hypnotics, antidepressants and anxiolytics, or even just ETOH, so you can give them 5-10mg IV versed and they are still wide awake and have memories of the procedure.
i guess the thing to remember about having concious sedation is that yes, you are concious. you still have the possibility of feeling discomfort... even if an IV a nalgesic is used, it will help change the perception of pain being present, but many people will complain of pressure, bloating, cramping, gas pain, etc, yet due to the versed, don't remember any of it. i've had a patient come up off the table, smack me in the head, pull his IV out, and then finally dozed off... and when he got up was like "wow that was great i didn't feel a thing" and i would never tell a patient how they behaved while sedated.. i think it's inappropriate.
i hope that helps answer your question.... :)

I sgree with you - I as a nurse would never tell a patient what they did or how they acted when they were sedated having a procedure. I have had EGDs and ERCPs in the past and none of the docs or staff have ever said anything about something I did, but not long ago, I had a root canal and the dentist gave me nitrous and a Halcion. He was rather irritated after the procedure, turns out I could not hold my tongue as still as he would have liked, he didn't have to be a jerk about it. I felt like I was 5 years old and was in trouble for spilling something.

Anne, RNC

tinybabynurse · Jan 8, 2009

I was given versed during a TEE and it had no amnesiac effect on me whatsoever, I remembered the whole thing...every detail. I wasn't using any other medication, prescription or OTC.

A friend of mine had to have some internal hemorroids removed and they used versed. It didn't have an amnesiac effect on him either, and apparently throughout the procedure the medical staff especially the doctor made horrible comments about him and made fun of his body. He has had to have counseling to get over the horrible experience.

PICNICRN, BSN, RN · Jan 8, 2009

in a procedure such as a colonoscopy, does the patient actually feel the pain and discomfort involved and simply not remember it? thank you very much.

My understanding is that benzos have no affect on pain- just sedation. So I would think yes- the pt would feel discomfort during the procedure but not actually remember. In my experience, we always use an analgesic(fentanyl/Morphine) along with Versed for a painful procedure. Now, if were talking about a CT or MRI that is not really painful- versed/ativan/chloral work great.

I've never had a colonoscopy, so I could not know how painful the procedure is. Maybe the rational is that it is not a "painful" procedure and only warrants a benzo??

sissiesmama, ASN, RN · Jan 9, 2009

I was given versed during a TEE and it had no amnesiac effect on me whatsoever, I remembered the whole thing...every detail. I wasn't using any other medication, prescription or OTC.
A friend of mine had to have some internal hemorroids removed and they used versed. It didn't have an amnesiac effect on him either, and apparently throughout the procedure the medical staff especially the doctor made horrible comments about him and made fun of his body. He has had to have counseling to get over the horrible experience.

Exactly!! There is just no excuse for saying demeaning things like that. I know when I'm in the hospital, I'm no beauty queen, and those gowns don't help much. And I'd be willing to bet your friend's doc had a few flaws he would rather not have a total stranger make fun of.

Anne, RNC

Anxious Patient · Jan 9, 2009

I'm wondering. What would happen if the patient wasn't given versed before surgery? Would they then remember and actually feel everything that happened to them while being operated on? Why aren't the drugs that put the patient to sleep and numb the body enough?