Pertinent Questions From A Reader

I got this response in my comments section, but I wasn't here in a timely manner.  However this person asks some very good questions which will be of interest to others.  Here's the comment:

"I am going for a wisdom tooth extraction tomorrow. 1 tooth, horizontally impacted. It has to be cut and drilled out since it's so tight.

The Dr. is advising conscious sedation with Versed and Brevital. I asked about doing it non-sedated and he said that it was close to a nerve and thought it would be safer to do it sedated since I won't move around as much.


My questions are, what are my alternatives to Versed. Can the Brevital be used by itself and does it have any of the side effects of Versed? Would using just Brevital require a higher dosage and risk going too deep in anesthesia and cause breathing problems?

What about just using NO and opiates. Or how about an oral or IV valium. Would IV valium have the same effect as Versed?"

Wow, this is overkill for a tooth extraction.  I had to look up Brevital as I am unfamiliar with the name.  Nobody has ever threatened to give it to me, and nobody has.  Askapatient has no information on it either.  Here's what I found out...  This Brevital is in the barbiturate family and can cause all the same symptoms as Versed.  Here's a quote "Depresses CNS (central nervous system) to produce hypnosis, anesthesia & retrograde amnesia WITHOUT (emphasis in original text) analgesia; in high dose, may be used to reduce ICP, (intercranial hypertension) and depress cerebral metabolism."  Here's where I got the quote from:Brevital (methohexital) dosing, indications, interactions, adverse effects, and more Sounds to me like it does a lot of the same things that Versed does.  I'm not sure about the RETROgrade amnesia... If you read the description of "retrograde amnesia" it's not good.  You lose memory from BEFORE the injection! That's different than Versed's ANTEROgrade amnesia.  Anything that produces "hypnosis" and "amnesia" only, without pain reducing qualities is suspect.  Brevital is used as an alternative to Propofol according to what I read.  Heavy duty for a tooth extraction.  Combining two different drugs of this type (Versed/Brevital) isn't something *I* would allow.

I'm sure it would be safer to have the dental patient not moving around, but sedating somebody into immobility by damaging their brain like this doesn't sound like a deal.  Versed itself makes you feel pain more accutely, according to some studies, so you may move around MORE!  Everybody has heard about the screaming patients in the colonoscopy suites, I'm thinking that giving a drug which could induce screaming and knocks out self control isn't the best thing to do when you are having oral surgery.

If it were me, given that this patient MUST be in a surgical suite with rescue items at the ready (Brevital) I would opt for some Fentanyl (opiate).  That's all, just the Fentanyl.  I haven't had the myriad problems of Versed with plain ole Valium, but why bother if you are not nervous.  I would say no to the IV Valium.  Fentanyl is a pain killer AND a mild sedative.  That's "sedative" in our uneducated minds, as in serene and untroubled, not brain dead like medical people use the word.

Thanks to this reader for bringing the Brevital to my attention.  After being blind-sided with Versed, I'm on the lookout for any other drugs which may cause me problems.  Like Brevital.  I also want to caution any dental patients about allowing the use of ARTICAINE instead of Novacaine especially in the lower jaw.  It has been known to cause severe nerve damage and pain for extended periods of time.  My dentist respects my wishes NOT to have the stuff.  The Novacaine wears off more quickly so they like Articaine better, but if you don't want it, they won't give it to you and they don't FIGHT with you over it, like they do over Versed.