Sunday, October 14, 2012

Reply From Allexperts

Here's a reply I got from Mike, crna.  I think this might be the same one I took to task for an article, since removed, he wrote about his srna days.  Too bad this is NOT the way it works in the real world.  I don't know how many times I have heard that if the patient doesn't want Versed, they won't get it!  Maybe it makes these guys seem more rational and normal to at least pay lip service to the idea that we can refuse Versed?  Other places (and in my own life) I find nurses arguing with patients and injecting them with Versed anyway.  I find nurses injecting Versed even after agreeing not to.  I find nurses implying that Versed was deemed 'necessary' for saving lives...  (what a crock)  Anyway here's the latest missive which claims that Versed won't be used.  I tend to believe this guy BTW, if only because of his previous encounters with me.  I have highlighted certain passages and added my comments.

Expert: Mike MacKinnon MSN CRNA
Subject: Versed/Midazolam
Date Asked: 2012-05-14 20:20:03
Date Answered: 2012-05-15 03:12:20

Mike, why do you think I got Versed for my axillary block?  I specifically said no drugs that would incapacitate me which would most certainly be Versed.  I have seen you mention that nearly everybody gets Versed...  Why would that be?  Everybody doesn't desire amnesia.  I don't understand WHY I need some nasty little drug like Versed even after I said no, for something like a nerve block.  I didn't get amnesia anyway, so was awake and watching my arm twitch etc.  You say that we can refuse this drug, but in practice it's far more difficult than you would you state.  I had a Beir block without any Versed or g/a the second time.  I'm trying to understand the unholy ZEAL that there is to use Versed.

Hi J-M

Let me first start by saying that if you as a patient ask not to have a specific drug then you simply shouldn't get it. (Thank you, that's what I want to hear!)

Now onto the question at hand!

I have done hundreds of blocks and I have done them with and without versed. When I talk to a patient I always tell them what I plan to give so that they can ask questions or let me know if they do not want it. Some patients are so incredibly anxious about having a needle placed that they cannot or will not be able to remain still when the block is being performed. These patients would be at serious risk for damage if they did not have some degree of sedation to calm them. However, if they did not want the sedation I would be fine with that and not do the block. Some patients are totally calm and when that is the case I do not give versed.  (I was totally calm, and I'm unafraid of needles.  In light of my declining ANY DRUGS WHICH WOULD INCAPACITATE ME, even if it was discovered that I needed a little something, why the Hell would they bring out a big gun like Versed?  Wouldn't a little Valium be enough?  I find that Fentanyl or Morphine tends to calm me down without the rest of the side effects of Versed.  Why can't I have that?  Wouldn't that be my choice to make?  I have offered my opinion that *I* would have been far happier if my bumbling crna HAD refused to treat me in the precise way I demanded!  I have no problem with people being honest with me and admitting that they are not comfortable with patients like myself.)Giving versed for blocks or before going back to the OR is a very common practice in anesthesia. This is because these events are anxiety provoking (not really) and often make the patient very uncomfortable. (I can live with uncomfortable, although after having 2 ORIF surgeries WITH a bone graft from my iliac crest for a snapped femur, I am understandably not too worried about stuff that happens in the OR, especially a stupid wrist surgery!)  While you mention amnesia the real use of versed is as an anxiolytic (decreases anxiety) (I didn't have any anxiety and for me this drug shot my anxiety level through the roof.  There is nothing like being unexpectedly rendered obedient and unable to speak after being very clear about this kind of thing NOT HAPPENING!  My blood pressure shot through the roof as well, so I'm having a hard time with all this "decreasing anxiety."  Quite the opposite.  Judging by the LIES my crna told about what happened to me, the real reason for Versed IS AMNESIA!  A simple drug like Valium can decrease anxiety without all the rest of it.)  and as you experienced not everyone gets amnesia from versed. (Oh but they TRIED!)  However, before I give anyone versed I tell them they may not remember (code speak for dense amnesia) going back to the OR and that it will calm their nerves (not true in my case and many, many others.  It doesn't calm the nerves at all, it's just that these patients CAN'T REMEMBER THE SHEER TERROR!  Their slack muscles prevent them from EXHIBITING terror.) if they were to ask not to get it I would not give it. (unusual Mike, truly unusual, but I believe you...)  To date I have never had a patient choose not to have versed though I wouldn't care either way as I only offer it for their comfort.  (I have problems believing this.  Clearly MOST people do not like the word AMNESIA.  I'm lucky I didn't stroke out in my chair when the lawsuit mitigation nurse told me that they tried to give me AMNESIA!Nobody *I* know would go for this.  Versed is waaaay too extreme a drug to give for mere 'patient comfort' in my opinion.)I cannot speak to every practice and how they interact with patients, only my own. In my practice I tell patients my plan, before i give each drug and answer any and all questions about the anesthetic experience before anything is given. It is just the right thing to do. I have had patients tell me they don't feel "right" after getting morphine and so i choose a different drug to take care of their pain. My job is to make the patient comfortable, meet their needs and respect their choices.  (I absolutely agree with this entire paragraph.  I only wish that this was true in general.  It isn't.  As an aside, I have a problem with Demerol.  How strange is it that I can refuse Demerol without any problems, but try to refuse Versed and it's world war 3?)

I hope this helps.


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