Patient A comes in for elective surgery (TAH BSO) and is in pre-op. Anesthesiologist sees patient and does the normal pre-anesthesia talk. Patient refuses Versed, is willing to have anything else instead, but refuses Versed verbally as well as writing this refusal on the consent form. Anesthesiologist says ok, fine. Anesthesiologist comes back with the pre-op sedative and injects it into IV. Patient starts to calm down a bit, and then asks the Anesthesiologist (who is wheeling her off to the OR) What was the drug she was given, A-man answers Midazolam, very quickly, mumbling. Patient is heard saying, "But, but, but" then she's out.
Is this legal? Is this ethical? Is it a patient's right to refuse a particular drug? I always thought that it was.....
To my knowledge versed potentiates the sleepy stuff. The same reason Demerol is given with vistaril or phergan, an antiemetic effect is nice but it makes the narcotic or other drugs work better and longer.
Earlier I read a post that I found very difficult to read as the use of English totally baffled me. I answered one aspet of the question, re reading it again, it still makes very little sense to me. I am pretty good with English as a second language, I mess up my a's and an s alot. This was so verbose, I missed the the fact that it was a solution to this persons problem. I am not sorry, as you usually like me in your instution to translate. Give and take.
This discussion brews another question....and that is, if the general anesthesia is adequate, then why is an amnestic really necessary?
Is an amnestic kind of like insurance preventing the 2% or so of patients who have some vague surgical awareness? Or is it insurance against poor anesthesia technique?
Why would an A-man jeopardize his good name just to be able to use Versed???? Why is it sooooo much better than wide selection of benzo's available?
Sis123,
I think I can explain why the use of benzo's is so favorable, specifically Versed. When someone is going to be anesthetized for surgery, there are 3 basic components to achieve: amnesia, analgesia/areflexia to pain, and muscle relaxation often with paralytics. So by using a combination of agents, you achieve balanced anesthesia. Benzo's contribute a major component of sedation, hypnosis, and amnesia (which most patients focus on...the desire to be asleep, unaware, and not remember the unpleasant experience of surgery.) As you may know, ativan and valium are other benzo's that tend to hang around long which may hinder waking the patient up. Versed is so widely used from this class of drugs because of its extremely short 1/2 life and duration of action. It's use pre-op is to help the patient relax, go to sleep and facilitate the next step which would be induction during which an ETT is placed and airway is secured. I hope this helps a little. I am so sorry to hear about the experience you described. I am a second semester CRNA student and I find what happened appauling. I hope your acquaitance follows YogaCRNA's good advice.
....Earlier I read a post that I found very difficult to read as the use of English totally baffled me. I answered one aspet of the question, re reading it again, it still makes very little sense to me. I am pretty good with English as a second language, I mess up my a's and an s alot. This was so verbose, I missed the the fact that it was a solution to this persons problem. I am not sorry, as you usually like me in your instution to translate. Give and take.
And speaking of chilling out...I really debated even taking the time to respond to this statement. I think it's really funny how you first attacked my humble solutions so hastily without even reading the the whole thread. When you realized you made a mistake you then lashed out and attacked my writing style. Sounds passive aggressive to me. Please, it's unnecessary. I'm all for freedom of speech & expression of opinions but let's keep this professional. Note to self, BarbPick: read and pay attention before you throw around insults and serious terms like "rape" and we won't even have to have these silly exchanges. That's all I have to say.
I guess the reason why this is somewhat overheated is because the main issue here is whether legal consent and a patient's right to refuse is less important that a doctor's ego. I would say that it is.
Also, Tenesma posting your experience about a patient with a clearly different scenario, and then ICURN going on to discuss it, caused confusion on this thread. ICURN, I do appreciate your explanation about the different benzo's and why Versed seems to be the favorite, but really, the bottom like is like Barbpick said, No means no, and if this happened to you, it would be an awful lot like rape. It is a matter of consent and denial of consent regarding this drug.
If using another drug is impossible, and a particular drug MUST be used, then a 5 minute discussion examining reasons why someone does not want the drug, and pursuing an explanation of why is MUST be used, would get most patients to agree to the use of the drug in question. For a dr. to insist upon the use of a drug that a patient has very boldly insisted against, and made specific notation on the consent form is INDEED just like rape.
No means NO.
Do women own their bodies? I think that they do.
I will certainly help this patient do all that Yogacrn has recommended. I do hope that the people who receive the letter will take notice.
Thank you for kind words. Yes many times threads get hijacked, as did this one. The inquiry was for a suggestion to help your friend. The one who felt violated. YogaCRNA did come up with a good way to process the medical Error.
I too have noticed a heated response to Versed. It's very odd. I had it used against me to gain compliance in an elective surgery. They didn't even attempt to have me sign an informed consent. (they knew that I would not sign anything that gave them permission to do a general anesthesia.) The CRNA who says he knows whats best, flagrantly violated me by using Versed to gain compliance. I told him I wanted to be "awake and alert" which has certain meaning to me and obviously something else entirely to a CRNA. I have a severe reaction to loss of consciousness and did not want it for a minor surgery! So, I get the "Vitamin V" with the explanation that it a muscle relaxant. It did not create the amnesia they wanted and I remember all of the pre general anesthesia up until they gave me the general anesthesia drugs, and plenty of them. I actually COOPERATED with the procedures even though I wanted to get up and run away. This is like a rape. I said no very loudly and constantly, yet I got exactly what I told them NOT to do. I have been called names, fear monger, stupid, insane to start with, and a whole host of other things by people who like Versed. No amount of complaining has budged these people or caused them to regret that they attacked me. No wonder people sue! I am in Pharmacy school now to insure that nobody EVER gives me drugs that I don't know all about! I have said this in another post and I will say it again, thank God for the OR nurses. The one in particular made sure that I was modestly covered as much as possible so that the hateful CRNA couldn't make any rude comments about my body at least. (He made crude comments about other things.) She also defended me when I woke up irate. I remember her saying "She told you she would wake up like this!" If SHE had been in control, I would never have gotten the treatment I got. I guess you can tell that I am passionate about Versed use. This is a dangerous psychotropic drug and should be treated as such!
without knowing your situation if you want to be awake and alert for your surgery just ask for anesthesia not to be present. Now if you are saying that you did not want a general anesthetic and you agreed to local MAC then that is another issue. Be mindful of the fact that a local MAC can be heavy sedation with the same drugs used to give a general anesthetic. Also many people awake from anesthesia fighting be it local MAC or general. this is not considered an adverse effect.
I gave permission for an axillary block and pain meds. Nothing else was to be used. I was very specific. I had reduced my own fracture before swelling started and the reduction I saw in the x rays was acceptable to me. Where I got into trouble was I allowed a surgeon to convince me that due to swelling that the reduction would collapse. I informed the surgeon in his office that general anesthesia was unacceptable for this surgery. I left a message with his office prior to surgery reminding him of this. I told the anesthesiologist and the CRNA that I was not to have general anesthesia and I further told them I was to remain "awake and alert." I guess I should have said "awake alert and oriented?" My idea of awake and alert is NOT what Versed does. In his (CRNA) notes he states that in the OR he told me he was going to give me a general anesthetic and that I did not object at that time. Of course at that time I was under the influence of Versed and COULDN'T object any more. I don't like general anesthetic and the fighting and the rest of it is so disturbing to me that I don't want it unless it's absolutely necessary to live. Now I can add that Versed is NOT TO BE USED UNDER ANY CIRCUMSTANCES, and I have an allergy medical bracelet stating same. I sure wish I had a different CRNA! (and anesthesiologist.) I would have signed myself out AMA if the CRNA had been honest about what he was doing. Conscious sedation was never mentioned, nor anything else really. No informed consent, nothing. Very bad. I have applied to nursing school...
Neveragain appears to be offbase in her allegations of the evil CRNA raping her by giving her versed, a "dangerous psychotropic drug". I have heard many tales throughout the years that are quite dissociated from reality, but in this case would question whether there are other factors at play in this line of reasoning?
I informed the surgeon in his office that general anesthesia was unacceptable for this surgery. I left a message with his office prior to surgery reminding him of this. I told the anesthesiologist and the CRNA that I was not to have general anesthesia and I further told them I was to remain "awake and alert." I guess I should have said "awake alert and oriented?" My idea of awake and alert is NOT what Versed does.
In his (CRNA) notes he states that in the OR he told me he was going to give me a general anesthetic and that I did not object at that time. Of course at that time I was under the influence of Versed and COULDN'T object any more. I don't like general anesthetic and the fighting and the rest of it is so disturbing to me that I don't want it unless it's absolutely necessary to live. Now I can add that Versed is NOT TO BE USED UNDER ANY CIRCUMSTANCES, and I have an allergy medical bracelet stating same. I sure wish I had a different CRNA! (and anesthesiologist.) I would have signed myself out AMA if the CRNA had been honest about what he was doing. Conscious sedation was never mentioned, nor anything else really. No informed consent, nothing. Very bad. 
I have applied to nursing school...
BarbPick
780 Posts
To my knowledge versed potentiates the sleepy stuff. The same reason Demerol is given with vistaril or phergan, an antiemetic effect is nice but it makes the narcotic or other drugs work better and longer.
Earlier I read a post that I found very difficult to read as the use of English totally baffled me. I answered one aspet of the question, re reading it again, it still makes very little sense to me. I am pretty good with English as a second language, I mess up my a's and an s alot. This was so verbose, I missed the the fact that it was a solution to this persons problem. I am not sorry, as you usually like me in your instution to translate. Give and take.