Re: Anesthesia for procedures

[Guest guest]

On Sat, May 5, 2012 at 12:50 PM, Jeff <jefftaylorps@...> wrote:

Thanks for this, Nena.  This is a good reminder to all of us to carefully ask what anesthesia is going to be used for any procedure--whether it be a colonoscopy or dental work.  One of the most commonly used anesthetics for such procedures is Versed, or midazolam, and there's a warning on the Norvir (ritonavir) label saying it should not be used with this drug.  Nor should Kaletra, which has Norvir in it as well.  

I'll never forget arguing with an anesthesiologist who had made his routine night-before-the-procedure call who insisted that he used Versed all the time and that " it would be just fine. "  When I questioned him carefully it turned out he didn't know about he interactions, or about the label warning--kinda scary.  Even then, it was like pulling teeth to get him to agree to use an alternative sedative.  Just another example about how we have to remain vigilant and actively advocate for our own healthcare.  Doctors often have an irrational attachment to using drugs they're familiar with, and don't always welcome change--even when warranted.

Surprised to hear any doctor is still using propofol for routine anesthesia--truly scary.  He must not care about his license or possible litigation....

Don't be so quick to condemn propofol; it still has its proper and legitimate uses. When I had my first colonoscopy, Versed was used first because that was everyone got. The doctor and her assistants were all standing around puzzledly waiting for me to fall asleep, while I remained wide awake and lucid. They asked me how I was feeling (I told them I had a really nice buzz going), and the doctor then asked again what meds I was taking. I told them (everything was on a special list I had brought along, but the form they were looking at didn't have enough room to list all of the drugs). I was taking some strong meds for my bipolar disorder. The doctor said, " Ohhhhh! Have Ginger (the nurse anesthetist) come take a look at this. " Ginger came and read my list, and said she knew what I needed: propofol. After the procedure was over, I was told to alert the doctors the next time I had a colonoscopy that Versed was ineffective due to all of my other meds, and something on the order of propofol was needed. Sometimes, propofol is exactly the right drug.

I think the main takewaway from your message is to make sure the GI specialists you see are familiar with treating PLWHA so that they are acquainted with drug interactions of any anesthesia used during a colonoscopy with meds you may be taking for HIV. And I strongly, strongly agree with your point about the necessity of being our own advocates in our healthcare. It's a disappointing reality that PLWHA often are better informed than their care providers, and that is one of the reasons I find this mailing list SO valuable.

Regards,Nick -- Nick , LSW

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