Saturday, July 23, 2011
Here are a few notable quotes about the use, misuse and overuse of Midazolam aka Versed.
"Failure to titrate the dose to the needs of the patient was noted to be a common problem. They did note that a high reliance on using flumazenil to reverse the effects of midazolam may have contributed to use of excessive doses of midazolam as well and conclude that the routine use of flumazenil reversal is not a good practice." (In my opinion any amount of Midazolam is an excessive dose. This is shocking! Failure to titrate when this particular poison is fatal in tiny amounts and if given quickly! As for the "needs of the patient" what a crock. Versed isn't given for the "needs of the patient" most of them time, if at all. Then they want to rely on an antidote so that they can over sedate people? This is crazy.)
"While all these issues appear in the detailed prescribing information on midazolam available through the FDA and other reputable drug information resources, practitioners seldom read through those details at the time a procedure is being performed. The NPSA rapid response report would suggest that a false comfort level with the “safety” of IV midazolam has developed and that understanding of the substantial risks involved has not been routinely appreciated. (Did you get that? A FALSE comfort level with the "safety' of IV Midazolam has developed!!! Understanding the SUBSTANTIAL RISKS involved has not been routinely appreciated!!! Ya think?)
"As a class, benzodiazepines are the drugs most commonly precipitating delirium (see our prior columns pertaining to and ) and they are on Beer’s List of drugs that should be avoided in the elderly (see our January 15, 2008 Patient Safety Tip of the Week “ ” and June 2008 What’s New in the Patient Safety World “Potentially Inappropriate Medication Use in Elderly Hospitalized Patients”). Yet their use continues to be widespread, both in inpatients and outpatients. When we are asked about topics a hospital should choose for conducting a FMEA (Failure Mode and Effects Analysis), we often suggest looking at benzodiazepine use (either in toto or just the parenteral use). When you do such a FMEA, you’ll be amazed at what you find in your organization. We truly, in most organizations, have developed a comfort level with the use of these drugs that is clearly not warranted." (I LOVE, LOVE, LOVE the last line of this one... Can you hear me now medical people?)
Thursday, July 21, 2011
Interesting thread; as a primary care provider and as a patient, I can verify that way too many people have significant problems with Versed (midazolam). It’s really a shame that this drug is used so much; many problems go unreported because they happen after the patient gets home and it’s hard for the patient to relate what’s happening to Versed administration. A physician in my group had a screening colonoscopy with 4mg versed and 100mcg fentanyl; doses that were certainly within range. Immediately after the colonoscopy, she became extremely fearful, had terrible nightmares and developed most of the common PTSD symptoms. Everyone told her that her symptoms were unrelated to the exam or the drugs; this is clearly nonesense. Six months later she still has serious memory and anger issues; I worked with her for nearly 20 years and she definitely has serious PTSD. I would avoid all Versed like the plague. Regarding the amnesic effect of propofol; it’s given in an induction dose, so you sleep and you are naturally unaware; patients wake up minutes after a propofol drip is stopped with no problems such as amnesia that I’m aware of. Adding small amounts of versed to propofol and fentanyl certainly decreases the amounts of drugs used, but at a cost: you get the undesirable versed effects and you lose the benefit of propofol. Even adding fentanyl to propofol makes no sense to me; with effective doses of fentanyl, a patient is slower to wake and likely to have a hangover. My previous colonoscopies were done without any drugs; I have seen too many patients have long-term memory loss from versed and other “sedation” drugs….My GI doc wanted to so my last colonoscopy with sedation, propofol only of course; docs rarely consent to amnesic benzos like versed, so I reluctantly agreed. I had a board-certified anesthesiologist do my case (not a nurse; CRNA are fine, but you don’t want an unsupervised nurse/CRNA giving you an induction drug like propofol). I’m in good shape and have no health issues; I got 500mg (yes, 50ml) of propofol for a 20 minute procedure. I was out completely and woke up with no hangover, no creepy amnesia, no problem. Too bad that everyone can’t afford to get propofol; many insurance plans only cover the cheaper amnesia drugs like versed because any nurse or physician can administer them.
I guess I'm not a stupid as crna's would like to imagine, because this PCP's thoughts parallel mine.
Tuesday, July 19, 2011
"My only child, 17 year old daughter Jenny Olenick, died in April from complications after having one wisdom tooth extracted. Versed was was of the several drugs given. She went into cardiac arrest and the oral surgeon never even got to remove the other 3 teeth. She was in a coma in the Ped ICU at Hopkins for 9 days, then eventually stopped all breathing. Thank you for this blog. Maybe it will save another child's life."
My deepest most heartfelt sympathy for your loss. I have a 12 year old daughter, an only child as well, and I can't even begin to imagine what you are going through. You try your very best to take good care of your precious child, just to have this happen when you thought you were doing the right thing. Horrifying! I actually allowed my daughters dentist to sedate her when she was 4. Naturally nothing was really explained to me. When I saw her eyes as they gave her the drug I knew I had made the wrong decision. Then they refused to allow me to accompany her into the dental area. Now I know why! Who knows how smart she could have been if I hadn't allowed Versed, or if it had been explained to me including the death part. I got lucky. I trusted them with my most prized possession and they betrayed that trust. Much, MUCH worse for you...
This also makes me feel sick in another way... I am angry that I was given Versed, in violation of my very clear instructions and in violation of every single law there is on the books as far as informed consent and patient autonomy goes. It absolutely wrecked my mind and caused unimaginable emotional suffering. However *I* am still alive! This little girl (to us Moms, young lady to others) Jenny Olenick, wasn't so lucky. (nurses and doctors, please do not bother to e-mail or post that it could have been one of the other drugs... I will not post it! We all know that Versed is notorious for this kind of thing! Look at the "side effects" and "warning label/black box" on the vial!) I decided to show everybody what some of the side effects of Versed are; This is from extended side effects - AOL Search Results
Versed Side Effects
Nausea, vomiting, and a slow heart rate are some of the common side effects reported with Versed. Side effects of the medication are mostly minor, requiring little or no treatment. There are, however, a number of potentially serious Versed side effects that should be reported to a healthcare provider right away. Among these more serious side effects are difficulty breathing, an irregular heart rhythm, and signs of an allergic reaction.
Monday, July 18, 2011
I was just reading your blog about JConnor. You are right. This person does reflect the kind of disrespect and non caring medical person we have been exposed to. As you know I spent 20 yrs. nursing. There are good and bad in the medical field but you, I and the rest of the VERSED VICTIMS know the truth. We are aware that the laws regarding informed consent are lost. Many medical personnel have found the loop holes and know how to cover it up in charts and patient records. Versed is often given with not only lack of consent but with out and out lies. Such is my case where I was told I was receiving Morphine. Versed, morphine don't sound alike at all. Further it is my belief that I was lied to because medical personnel wanted to do what they thought was BEST for me. As it turned out I guess respiratory arrest was BEST for me. Of course I had the usual side effects from Versed. PTSD, depression, long term memory problems that medical people deny happens. Yet I have an answer to a letter from a doctor who confirms these side effects are happening. Also the research to confirm it. And too bad for the people who have used Versed all these years to mistreat patients and leave them too suffer for their BEST interest. There are 841 posts on askthe patient at my last count. Getting close to one thousand. Out of those the average rating is 2.5 out of 5. This is an awful high dissatisfaction rating for such a marvelous drug. Am I angry. You bet I am. I say keep up the good work and do not let people like JConnor stop you from spreading the word. We will no longer allow medical; personnel to treat us like cattle. We will stand up for our rights and we will not allow versed to harm anybody if we can help it. I hope JConnor doesn't end up one of the 10 percent that so many other medical personnel have.
Love you always Linda
PS You have my permission to post this for JConnor to see if you desire.
Sunday, July 17, 2011
This one is from 7/9/11 and is a 50 year old man. "The rating is a 1 which means that Versed is no good and they would not recommend this drug!
REASON GIVEN; "colonoscopy"
SIDE EFFECTS; "Anger, depression, memory issues, unable to return to work the next day.
COMMENTS; "Was flat out told that I'd be awake and responsive, not 'out.' Was not told of the amnesia. I was shocked and then angry when the process was complete and I had no recall."
This one is from a 62 year old female on 7/11/11 The rating is a 1 once again. Here's what she says;
REASON GIVEN; "Cataract Surgery"
SIDE EFFECTS; "Smallest dose possible (so they said) was administered twice one week apart for cataract surgeries. Five days after the first administration I started experiencing obsessive thinking, anxiety, depression, sleep disturbances, loss of appetite, and weight loss. I went to bed anxious, with pounding heart and difficulty breathing and woke up depressed. The slightest thing made me angry. All of this was SO unlike me. I could not control my thinking, something I'd never experienced. I felt as though I'd been turned into someone else, and I had no idea what caused it. It was horrible."
COMMENTS; "Fortunately I am mostly back to normal (8 weeks later), except for lingering memory issues which I hope will eventually resolve. I will NEVER take Versed again. I just hope medical profession takes me seriously and doesn't decide to stick it in my IV anyway. Nothing would surprise me. THANK YOU to all the people who posted here, helping me to understand the reason behind the dramatic and terrifying change in my mental state."
Does this really sound like a safe drug? How many more of us have to go through this experience with Versed for the medical people to LISTEN TO US? Too many of us are having these problems after Versed for it to be a coincidence. We are not all going on Facebook and arbitrarily deciding that Versed is a bad drug. We are talking about it because it IS a bad drug for way too many of us. We are comparing notes, not indulging in self pity. We are looking for answers because the medical community is guarding this drug with their life! Claiming that we are suffering from some kind of delusional thinking makes us think that medical providers are delusional themselves! How can you deny something that so many people are experiencing? We can't ALL be wrong, now can we?
Monday, July 11, 2011
"Out of necessity, I do send clients to the nearest veterinary school center when I’m not available (funerals, CE, root canal). Not popular, and do this with the wrong person and you’ll probably lose both the client and all her friends. The horse-owning population is in communication to an alarming extent. One wrong move, it’s all over FB, IM and the bulletin boards, and you’re toast."
LOL That's right, we horse owners are "in communication to an alarming extent." While we are generally more concerned with our precious horse than ourselves, we do get injured on a regular basis, horses being what they are. I talk about what happened to me, show them my arm and how my fingers and hand don't work so well any more. I name names... I talk a LOT about how my anesthesia nurse assaulted me, and my reaction to Versed as well. Remember that song "I Heard It Through The Grapevine?" Horse people have a great "grapevine" and we're all mostly real local. I sure hope that I was "the wrong person" to treat like dirt.
Wednesday, July 6, 2011
Also they are having a problem with me pointing out that "patient cooperation" means abject obedience. Funny how that works. Sedation doesn't mean what normal people think it does, sleeping isn't what we all thought that it was and amnesia is used to describe states of being that do not apply. I know, it's clear as mud...
Which all leads me to this study... Propofol versus midazolam for conscious sedation g... [Endoscopy. 2000] - PubMed result
Here we have an article which describes "patient cooperation" as being much better with Propofol than with Versed. Does that sound like the patient is asleep? How obedient are you when you are asleep? They are describing AMNESIA once again and ominously that creepy "patient cooperation." Don't trust any of it. Unless and until these medical workers can use terminology which is CONCISE and DESCRIPTIVE of the true state of your being and your mind, I wouldn't trust them with any kind of "sedation" drug. They are obviously lying through their teeth about the true nature of Propofol AND Versed/Midazolam. We are not "asleep" with these drugs. We are not "sedated" as in serene, we are mindless zombies. We are capable of feeling and living through torture, but not capable of resistance. We are NOT cooperating in the true sense of the word, we are cravenly obeying their every command. Cooperation denotes a joint effort, a willing participation. Not possible if you are drugged into obedience. I didn't willingly cooperate with anything. I was forcefully drugged into submission.
I would be very leery of accepting Propofol...
I put this post up years ago. Since then I have had a recent experience with surgery in regards to my daughter's broken clavicle. Given the choices, we (anesthesiologist, myself and my 17 year old daughter) decided to go with Propofol as the sole agent. As it turns out, Propofol is NOTHING like Versed. I cautiously recommend that you speak to your anesthesia provider about this option. It worked like a miracle for my daughter. No brain function loss, no long delay in the PACU, it was as if she never had surgery. Believe me I was very critical in my examination of my girl, and I could see zero ill effects, and she stated there were none. (updated on 19Nov16)
This is the site; Critical Care Full text A prospective randomised pilot study of sedation regimens in a general ICU population: a reality-based medicine study
Here is the quote "Our recommendations for future sedation studies include the use of measures other than the sedation score to evaluate the adequacy of sedation. Studies conducted in our unit suggest that patients surviving ICU are disturbed by having no memory of that period of their life . Thus, what appears to medical and nursing staff to be an ideal sedative agent, in particular more recently available short-acting anaesthetic agents which provide titratable sedation, but by nature of their very short duration of action allow patients to be heavily sedated without the risk of significant accumulation, may encourage staff to oversedate patients. Despite the patients being 'well-sedated', they may later be disturbed by having no memory whatsoever of their time in ICU. This is an area of ICU practice that requires considerable further study."
"Studies...suggest that patients surviving the ICU are disturbed by having no memory of that period of their life." Wouldn't this be exactly the opposite of what JKW opines? Here's another of the same thing "Despite the patients being 'well-sedated', (this would be according to the medical people and would be THEIR opinion) they (patients) may later be disturbed by having no memory whatsoever of their time in the ICU." This pretty much puts paid to the insufferably arrogant claims by anesthesia about us wanting, desiring and begging for amnesia don't you think? These patients are DISTURBED by their lack of recall. If you are an anesthesia provider, don't you dare claim that since the lack of recall is SHORTER in procedural patients that it isn't just as disturbing to them.
Notice also the "may encourage staff to oversedate patients." Of course it is. No question about it. Given that they all seem to feel that Versed is the most wonderful drug in the world and has zero side effects, what's to stop them? It makes their job so much easier to take care of amnesia afflicted zombies instead of relating to their patients and actually caring for them. FYI there is a law on the books which if followed would put a stop to this... Which is that chemical restraint cannot be used for the convenience of staff. They always always claim that it's for the patients own good, that the patients want and demand it etc. Not exactly... It seems that for the most part Versed is for the ease and convenience of staff.
And yet, if you use your search engine and look for Versed/Midazolam+patient cooperation you will find study after study and report after report on just that. I have "zero credibility" for claiming this, but this is exactly what happened to me! I was given Versed and THEN when I couldn't resist them any more, they CLAIM, IN WRITING, that I gave consent for g/a (which I had vigorously declined) by "NOT OBJECTING." It's all in writing folks, there is no way around this one. Aaron told this laughable story to the nursing board AND the board of Health and Welfare. My CRNA of course omitted any mention of Versed OR sedation. It's against the law to 1) give me sedation in any form if I have declined it. and 2) It is illegal to get consent for anything after sedating the patient. and 3) It's illegal to get consent in the negative, I.E. by the patient being unable to object. The CRNA JWK is in complete denial and is attacking me as if that will prove their point. It's another one of those Alice in Wonderland conversations with the mad hatter.
My statement isn't absurd. I WAS given Versed to gain compliance with yet MORE drugs and procedures which I had also declined. Versed was sneaked into my IV with the "simple muscle relaxant" line. What else could Aaron do? I had declined sedation, so he had to do something to get me to do his bidding. Aaron was trying to give me amnesia (which was never mentioned until well after surgery) and he needed to get that "patient cooperation." None of this was for my benefit at all. I still wonder what he was thinking! Did his little fantasy lead him to believe that I would APPRECIATE him doing whatever the hell he wanted to me, against my will? Really? Was he so concerned about his 800 bucks that he wasn't going to let me get away with demanding to go home AMA under the circumstances? (sedation and g/a) Is he conditioned to believe that he "knows whats best" despite all evidence to the contrary? Despite the howls of denial from JWK and all the rest of them, this IS what happened to me. Their denials give them that "zero credibility" that they would like to assign to me...
There are even more "absurd" accusations on WWW.NURSE-ANESTHESIA.ORG, you need to go read them! It's pathetic.
Monday, July 4, 2011
Saturday, July 2, 2011
Hexanchus June 6, 2011 at 6:34 pm
It’s actually not that hard to do – you simply write “I do NOT consent to the use of general anesthesia or sedation of any form without my specific written prior approval.” on the surgical/anesthesia consent form. Now that you have established the ground rules, you can have a dialog on what possible anesthesia interventions might be applicable under specific circumstances, what the potential risks and benefits are, and decide on a modified consent based on specific triggers or events based on what you feel comfortable with.
It helps if you have discussed it with your surgeon ahead of time and can tell the anesthesia provider that. You can also do the same with any other procedure/intervention such as intubation or catheterization if you wish.
FWIW, I agree with with you on the overuse of sedation (and will add amnesic drugs such as midazolam to that). Bottom line, they are going to want to do what’s easiest for the OR team – not necessarily what’s best for the patient. Unfortunately, if you leave it up to them, most providers will revert to doing what they are used to and most comfortable with – that’s just human nature. I think that if providers would truly take the time to discuss the risks and potential side effects of these drugs, more patients would opt out.
With the advent of better regional anesthesia techniques, the real need for G/A, along with it’s inherent risks, should be significantly reduced. In India, for example, they have done well over 1000 successful open heart procedures of various types (CABG, valve repair, etc.) on awake, non-intubated patients using thoracic epidural anesthesia. They’ve been doing it there for years – unfortunately it hasn’t caught on here yet….. I believe that areas like this is another place where both the costs and the risks to the patient could be reduced.page.
This post is exactly what I had imagined would happen. I told my surgeon that I was uninterested in general anesthesia for my extremity surgery. I explained fully my previous surgeries, my paradoxical reactions to g/a drugs AND the fact that I couldn't afford this level of intervention. I wanted regional anesthetic ONLY! My surgeon claims he only heard the affordability part, but even that didn't register. He stated afterwards that he only works on unconscious patients. He didn't reveal that to me, or in any way suggest that what I wanted was not important to him. So while I thought that my surgeon and I were on the same page, the opposite was true. I expected my surgeon to make sure that the anesthesiologist (an MD, I never even heard of a CRNA, nor would I have allowed one to be my anesthetist) followed my instructions. The opposite was true. My CRNA also disregarded every single thing I said to him, and the rest of the staff shockingly went along with the whole scheme. Not one single person told me, or in any way indicated that they were not in favor of forcing me to accept way more intervention than I had clearly outlined. In my opinion, the people who work in a medical setting are so intent on doing things "their way" that they totally disregard anything the patient says. Not one person defended my wishes or informed me that they were going to dismiss me in such an egregious way. Yet *I* am the control freak...
The "sedation" I am talking about IS Versed! Here this poster says that Versed is overused. Thank you! However as a drug to insure that the patient accepts everything that the money grubbing lazy people in the medical treatment facility want, it is absolutely perfect! Not only are the patients stricken with an abnormal desire to obey, they usually have amnesia and can't argue about whether or not they agreed to things, and they can't know that it was all completely unecessary...
Since there was no anesthesia/general anesthetic/sedation "informed consent" AT ALL, I was unable to cross out the things that I didn't want. My CRNA even states that I "agreed" to all kinds of stuff that I had no intention of having. I said NO! I got it ALL anyway. Course there were all kinds of excuses as to why that was. They were all lies, but it doesn't matter.
If you look at my post pertaining to how to avoid getting Versed, you will see that some of what this poster says are also what I am advising. However this isn't foolproof! My own sister wrote in big red letters that she wasn't to get Versed and also wrote on her arm where the IV went, not to give her Versed. They agreed and of course she got Versed.
How I wish it was as simple as this poster says it is! I have been pretty much hysterical about medical care ever since my ORIF Distal Radius reduction debacle. I have been very worried about open heart surgery, (or similar) my paradoxical reactions to anesthesia drugs and now Versed, and have even advised my husband to wait until I turn blue before getting me any medical attention. Now this person says that this type of surgery is done in other countries without all of the above. There is hope!? How do you do open heart surgery on a patient whose body fights on, even after being cold cocked by drugs? I understand the suc. etc. but what about when I wake up fighting and in restraints? (I believe that part is called emergence delirium and I think that is why my jerk of a CRNA gave me 4 mls of additional Versed AFTER THE DAMN SURGERY WAS OVER!) Wouldn't I damage myself?
ONE SINGLE CRNA with a syringe of poison caused this kind of ongoing anxiety and the rest of them have rallied behind him and further damaged my trust. Nice going nurses.