I wrote about the miracle of Propofol and want to talk about that a little bit more. Propofol was a miracle drug for my daughter. Would I allow Propofol to be used on me? Maybe, maybe not.
I have read way too many articles talking about the "patient cooperation" with Propofol. To me, that doesn't sound like "asleep." Sorry, I find that disturbing, especially after the Versed debacle. The "amnesia" didn't work for me with Versed and the absolute HORROR of being unable to move or speak efficiently and the crawling subservience to the medical minions every whim was more than I could deal with. If I could describe the level of freakiness for you I would. Follow that with waking up from the general anesthesia I had FORBIDDEN, on my feet trying to kill people with my cast, I have a very deep issue with any drug which renders you obedient, incapable of stopping the procedure and which produces a profound personality change. Since NOBODY will tell the truth about these drugs, I have a hard time swallowing the happy clouds descriptions. "Superior patient cooperation with Propofol" comes close to sounding like Versed, only worse.
I saw the results of using Propofol on my daughter and it was an incredible drug. Would it be safe for me and others who have already had a problem with Versed? I-don't-know. Depending on the medical issue, if Propofol were the least of the anesthesia options I would choose it. MAC is out of the question as is general anesthetic. I have had very good results from regional blocks without sedation so that would be MY first choice. Performed by a doctor of course. For more invasive procedures which cannot be performed with a block, then Propofol. The thing is, for people like me, all this sedation, MAC and general anesthetic is complete overkill. Why would we need all this crap for some minor procedure? It boggles the mind.
I would accept Propofol as a last resort only.
PS After the debacle with my distal radius fracture (see the "vast improvement" in the x-rays, which is actually minuscule. Keep in mind that I reduced that fracture on my own before I ever saw a doctor...) If I had the same fracture as my daughter, here is my plan...I would tie a rope around my wrist, then shut a door over the other end of the rope about shoulder height and pull until I could tease the widely displaced ends of the bones together again. The roughness of the fracture will help hold the bone ends together. A nice brace to hold that shoulder back until it healed and voila, problem solved. If you can't handle that, Propofol might be a good choice so the medical people can fix it for you.
I had propofol for the first time earlier this month for an upper endoscopy with esophageal dilation. It seems like within the past year or two virtually all GI endoscopy units are utilizing propofol for sedation with CRNAs.
ReplyDeleteMy impressions:
1. I didn't know exactly when the drug was being infused, as I was on my left side and my right arm was out of view and under a blanket. There was no transition, after a half minute or so of laying there it's like I blinked and opened my eyes to my husband touching my hand in recovery. I was blindsided. I knew the effects would be lights out, lights on, but it's something you don't appreciate until you experience it. AND I HATED IT.
2. The EGD took only 6-7 minutes, but I was asleep for close to 30 minutes! I woke up 20 minutes after the scope was removed. Everyone says you wake up within 10 minutes of the drug being administered. However, I had a talk with a nurse at the practice today because I had questions and she said it really affects everyone different, 20min after the end of the procedure was well within normal and that I was not asleep, it was CONSCIOUS SEDATION (the record calls it MAC though). She said she's affected 5-6 hrs when she gets it (come on now, that's not normal, stop pretending it is). Anesthesia providers, however, call it DEEP SEDATION or light GA because you are ASLEEP but still rousable.
3. My husband had propofol for upper and lower GI scopes in one appointment. 35 minutes in the procedure room, they wheeled him out right after they finished and he was waking up. The nurse called me as soon as they wheeled him in the recovery bay and told me he'd already woke up and he was sitting up. I was told in my case I wasn't wheeled right out but was getting post-procedure monitoring. Really, 20 minutes worth of checking vitals for so-called CONSCIOUS SEDATION? The nurse I spoke to said I wasn't completely out (she wasn't there). My husband said I was out, fast asleep when he walked in, though I sprung awake when he touched my hand.
4. The GI nurse at intake pre-procedure used the phrase "we put medicine in your IV to make you sleepy" after saying they'd use propofol. When I corrected her and said "Come on, you're putting me under, I will sleep through this procedure," she said, "patients get a bit upset at being told they'll be put to sleep." I absolutely hate health care practitioners not being totally straight up with me.
5. I think I was oversedated. I requested the anesthesia report to see all I actually got and what my vitals were. I put off getting an EGD done after 7 yrs of severe heartburn and food getting stuck not because I feared the scope, but I couldn't bear getting sedation. After I had some food get stuck for nearly an hour and I was in pain and gagging the whole time nearly a year ago, I knew I had to no choice but to get it dealt with. When I presented with anemia before having a thumb arthroplasty in June, that upped the ante, and I also scored an early colonoscopy at 46 because I also have a family history of colon cancer.
When I got the colonoscopy done 10 days later, I did it stone cold sober. It was uncomfortable, but not really painful. It was quite gratifying and enlightening to see my innards on the monitor. My doc (a lady, not the one who did the EGD but my regular GI doc) was great to work with. Fortunately, my colon was normal. I will get all my future colonoscopies done unsedated and I wish more people would try it. When I had my thumb arthroplasty in June, I had it done with a straight up nerve block. I had a small umbilical hernia repaired 10 yrs ago with only local and some fentanyl. It was a piece of cake. Because I'm a classically trained singer, I avoid GA because of the risks of intubation damaging my larynx. I try to avoid sedation because I hate feeling out of control and prefer to always know what's going on (I'm a web developer/music major/former premed student and an intellectual nerd).