Guys & Gals -- Thanks for the replies! For this micro-survey Propofol is the winner, but the only significant difference being how quickly Propofol flushes out of your system. And no one has heard of any evidence that Versed causes any kind of permanent memory problems..................
I have never heard of any, and we gave it by the gallon, considering all of the 1-2+mg doses X thousands of pts.
As some one said, all depends on how quick you want to be aware. As for your health care providers, versed + fentanyl or whatever can not touch propofol used in combination or by itself. It is a much easier work experience for the GI doc or surgeon or whoever, as well as the anesthesia provider, when propofol is used. You stay nice and still, if you are moving too much it is easy to titrate it just right so that you are don't move but are still breathing adequately on your own. And then, no matter how much or how little we had to give you, once we stop giving it you are pretty much wide awake to the point it's just like you have not had anything at all(if propofol was used by itself)
Also, there might be a safety advantage of having an anesthesia pro giving the propofol. On the rare occasion that, while trying to give you just enough to be still and quiet we give a little too much, you are still going to be at least trying to breath. As long as we can physically keep your airway
open, you will suck in enough oxygen to be fine, and if we don't give anymore in just a few minutes you will be back to normal, and in a few more you will be wide awake if needed. If you give too much fentanyl or demerol while trying to get some one to be still, then they will just stop breathing, nno matter that the airway is
open. Then we have to scramble around and in a big hurry give narcan, which completely reverses the fentanyl, and there we are again back where we started- you are breathing good but have no pain relief. Or, we have to ventilate you with a mask or put in a breathing tube, which we just do not want to do on any kind of regular basis for these short procedures. That's all way too much hassle and results in too much provider high blood pressure and rushing around. That is why, IMHO from a provider standpoint there is simply no comparison between propofol alone vs anything else. That is why these last few years GI docs just love it when insurance- or the pt - pays for anesthesia folks to come in and give propofol. It just works so much better for all concerned, plus the GI doc does not have to be concerned with anything but his scope.
But for you, the patient, if you do NOT have a particular need to be bright eyed and bushy tailed 10 minutes later, and don't even care that much that you might possibly be groggy many hours later, it is probably 6 of 1, 1/2 dozen of another. If an adequate dose of versed is given, you could be thrashing all over the table, but as far as you know you were out from the moment they injected you until some time period after the procedure is done. It seems all the same to you. Still, I think there is that safety advantage. First you have the anesthesia person in there whose only concern is your airway, blood pressure and adequate anesthesia, the things he takes care of all day every day. And 2nd, you will have less concern that the GI doc or his assistant will- while trying to give you enough to be still- gives you too much fentanyl so that you stop breathing- or your rate drops to 1 or 2 a minute, even if just for a minute or 2 while the GI doc scrambles to correct this problem.
Versed provides total amnesia, and depending on dose a little grogginess or even light sleep. From which you can be awakened unless the dose is really big. IV Fentanyl provides almost zero sleep or sedation. It just provides profound pain relief very fast. You can be quite awake with fentanyl in you, even a larger dose that they may have built up to trying to get you adequate pain relief so you can hold still, wide awake but not breathing. But, if it's only fentanyl and no versed, at least you will breath when we tell you to breath, because you are awake. But if you have versed in you also, you may well NOT do us the favor of obeying a command to breath, so out come the ambu bags and maybe tubes and all of that. A big downer for us, but as long it is all quickly corrected by competent folks, you won't know the difference as long as you have been given adequate doses of whatever.
But me personally? I would only want to administer propofol for deep sedation, preferably by itself. And for various safety reasons, I would rather have an anesthesia pro giving me the propofol by itself. But when it is all over, other than waking up quickly(maybe so quick that I insist I never went to sleep) I'm not likely to the difference no matter which way they went.
Post Edited (BillyBob@388) : 9/2/2014 12:56:32 PM (GMT-6)