IV Sedation

I am going to be having cataract surgery in February (aging is so much fun!!). I just inquired about the anesthesia I will be getting. It is an IV sedation of fetanol and midazolam.
I am doing so well after my last touch-up ablation that I do not want to do anything to affect this wonderful normal sinus rhythm.

I intend to send a messenge to my EP team, but, with all of the knowledge in this forum, I wonder if there is any information you can give me about these drugs and AFIB.

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Pixie
I am going to be having cataract surgery in February (aging is so much fun!!). I just inquired about the anesthesia I will be getting. It is an IV sedation of fetanol and midazolam.
I am doing so well after my last touch-up ablation that I do not want to do anything to affect this wonderful normal sinus rhythm.

I intend to send a messenge to my EP team, but, with all of the knowledge in this forum, I wonder if there is any information you can give me about these drugs and AFIB.

I am getting cataract surgery on January 20th and most likely will be given the same medications for conscious sedation. I have had them several times before and, as far as I know, there are not problems for Afib. Midazolam is a benzodiazepine (Versed) and fentanyl is used for short anesthesia (tiny dose, no worries). I have a clearance from Dr. Natale (required because of my recent ablation) and their only concern was that I not stope Eliquis—but you don’t even have that concern as you have a Watchman!

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Daisy

I am getting cataract surgery on January 20th and most likely will be given the same medications for conscious sedation. I have had them several times before and, as far as I know, there are not problems for Afib. Midazolam is a benzodiazepine (Versed) and fentanyl is used for short anesthesia (tiny dose, no worries). I have a clearance from Dr. Natale (required because of my recent ablation) and their only concern was that I not stope Eliquis—but you don’t even have that concern as you have a Watchman!

Thank you for your response, Daisy. It is good to know that Dr. Natale cleared this. I will be letting my team there know this when I send my weekly reading on Friday.
I was told Eliquis did not have to be stopped for this procedure.

As an aside, after the results of my first TEE, I was told, in general, that I could stop Eliquis for7 days if I needed to.

Hope all is going well with you.

They have to give these kinds of medication for cardioversion and for endoscopies and colonoscopies. It seems to me that, if they will give fentanyl and propofol or midazolam to heart patients, it must be fairly safe. I had fentanyl and propofol three times last week for three separate cardioversions. They didn't work. The cardioversions. The chemicals did what they're supposed to do.

Fentanyl and propofol have become favored anesthetics because of their cardiovascular stability. Many other anesthetics can cause significant drops in blood pressure.

I'm rather surprised they used fentanyl AND propofol for a cardioversion. I've had a lot of cardioversions at 3 different centers and all used propofol only.

Thanks for responding . gloaming, I am sorry to hear about the cardioversions you had last week.

The fentanyl, according to the person supervising, was to reduce pain. Some find propofol painful when it is administered. People in pain need more mollifying, probably more sedation, which isn't a desirable circumstance.

I didn't feel anything in either case, although I took a heckuva long time to finally cave and go to sleep. The physician, who had done the procedure the day before, kept asking me mathematical questions, and even asked me if Pluto is a planet. Jokingly, although unable to keep my eyes open, I replied, "No, Yes. No....it depends on who you ask." He looked at my wife and shook his head. Next day, for the third cardioversion, he came to the door, leaned against it, and huffed, jokingly suggesting this was getting tiresome. Good guy.

Thanks for your kindness, Pixie. I wouldn't wish my condition on a living soul. I can't enjoy any hobbies. Even food is losing its appeal. I fear I will actually have to present in dire straits at the ER, at which my EP will be contacted and he'll likely agree to see me within a few days. Happened to our organist at church. Spent the weekend in our local ER, and they couldn't shift his flutter. Off to Victoria he went, he and the missus driving, and I believe he had his ablation within 24 hours.

"The fentanyl, according to the person supervising, was to reduce pain. Some find Propofol painful when it is administered. People in pain need more mollifying, probably more sedation, which isn't a desirable circumstance."

About 30% of the time of my many ECV's the anesthesiologists wanted to use Fentanyl. I tell them them I would rather not, and in all but one occasion, they accepted my request. It does reduce the pain that Propofol can cause in the arm when they first give it to you. I think the lower the IV is on your arm, the greater chance of the Propofol being painful. Also the more times you have this done, the less painfull it becomes. Sometimes when I had the IV in my hand/wrist area, it was very painful, but it was of brief duration. I believe when Fentanyl is given it lengthens the recovery time to get back to normal after the procedure, and that is why I don't want it.
Also you have to ask them what they are giving you beforehand, or they probably won't tell you. When the anesthesiologist comes in 5-10 minutes before the Cardio Doc, he/she asks you several questions, and there is time to discuss this at this point.



Edited 1 time(s). Last edit at 01/10/2023 04:47PM by The Anti-Fib.

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The Anti-Fib
I believe when Propofol is given it lengthens the recovery time to get back to normal after the procedure, and that is why I don't want it.

Assume you meant fentanyl?

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The Anti-Fib
...
Also you have to ask them what they are giving you beforehand, or they probably won't tell you. When the anesthesiologist comes in 5-10 minutes before the Cardio Doc, he/she asks you several questions, and there is time to discuss this at this point.

Not at my hospital. In fact, when the nurse was flushing out my IV immediately after its insertion, I made a move to inquire and she interrupted and said she was just doing the flush. She added that she would never administer a drug of any kind without informing me first. The physicians all took the time to explain what they would do to me, step-by-step.

This is as it should be. Informed consent is the basement on which all ethical practices are constructed.

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GeorgeN

Assume you meant fentanyl?

I just realized a did not spell fentanyl correctly in my post. Sorry about that.

That's because about 90% of all people who use the term, including a great many professionals of all kinds, mispronounce the word. You can be forgiven, Pixie.

A medical provider absolutely cannot refuse to tell you what drug they're administering. I would get up and leave if anyone couldn't or wouldn't tell me. If I was unable to leave, I would refuse the drug.

So, do people find that fentanyl or propofol increases the time to recover from grogginess? I’ve had fentanyl and Versed together a few times and wondered which caused more grogginess. When I have cataract surgery I’d like as little sedation as possible so as to be clear-headed to drive to the check-up appointment the next day. If fentanyl is the groggy culprit, I’d ask if they would just give Versed. Benzos don’t usually leave me groggy.

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Carey
Fentanyl and propofol have become favored anesthetics because of their cardiovascular stability. Many other anesthetics can cause significant drops in blood pressure.

I'm rather surprised they used fentanyl AND propofol for a cardioversion. I've had a lot of cardioversions at 3 different centers and all used propofol only.

I may have the ecv record here. One cowboy dr at the er gave me three at once for an ecv- fentanyl, propofol and etomidate when I had v-tach from my flecainide overdose.

Propofol alone leaves you completely clear headed 20 minutes after it wears off. Fentanyl and Versed not so much.

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GeorgeN

I believe when Propofol is given it lengthens the recovery time to get back to normal after the procedure, and that is why I don't want it.

Assume you meant fentanyl?

Yes, thanks for the correction

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gloaming

...
Also you have to ask them what they are giving you beforehand, or they probably won't tell you. When the anesthesiologist comes in 5-10 minutes before the Cardio Doc, he/she asks you several questions, and there is time to discuss this at this point.

Not at my hospital. In fact, when the nurse was flushing out my IV immediately after its insertion, I made a move to inquire and she interrupted and said she was just doing the flush. She added that she would never administer a drug of any kind without informing me first. The physicians all took the time to explain what they would do to me, step-by-step.

This is as it should be. Informed consent is the basement on which all ethical practices are constructed.

Yes, but I think most of the time they would just say they were going to administer the Anesthesia (Propofol), right before they do it. In my expereience, (close to 45+ ECV's ) they don't get that precise to mention if they are specifically adding in Fentanyl. They have certainly always explained to me that they were about to knock me out.

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The Anti-Fib
Yes, but I think most of the time they would just say they were going to administer the Anesthesia (Propofol), right before they do it. In my expereience, (close to 45+ ECV's ) they don't get that precise to mention if they are specifically adding in Fentanyl. They have certainly always explained to me that they were about to knock me out.

The opening post was about cataract surgery and I also have it scheduled in a bit over a week. They called today and we discussed anesthesia — they said that they usually give Alfenta, which is similar to Fentanyl. I looked it up and it has a major interaction with Multaq (which I am taking) and it is metabolized through CYP2D6 (I am a poor metabolizer of CYP2D6). Both of these would increase the level of Alfenta so they are going to call tomorrow to discuss it further. Just to say, good to check drugs yourself. They would probably catch the interaction with Multaq but they wouldn’t know about my problem with CYP2D6.

Good catch, Daisy. Informed patients are patients who stay alive.

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Carey
Good catch, Daisy. Informed patients are patients who stay alive.

Isn’t it a shame we have to be our own advocate to avoid iatrogenic issues because we ask questions to stay informed?

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Carey
Good catch, Daisy. Informed patients are patients who stay alive.

I certainly agree with you, Carey. I do look up drug interactions, etc. I am learning so much through this forum. I consider myself fairly versed, but am not familiar with CYP2D6.
Now I have to research that. Being our own advocate overwhelms me at times! I am glad this was mentioned in Daisy’s post.

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Pixie

Good catch, Daisy. Informed patients are patients who stay alive.


I certainly agree with you, Carey. I do look up drug interactions, etc. I am learning so much through this forum. I consider myself fairly versed, but am not familiar with CYP2D6.
Now I have to research that. Being our own advocate overwhelms me at times! I am glad this was mentioned in Daisy’s post.

It surprises me that they so rarely look at mutations in genetic pathways when some level of genetic testing is so common with ancestry sites etc. I learned the hard way about CYP 2D6 when I got complete heart block from a dose of Flecainide that was th retically safe. (Flecainide is metabolized through CYP2D6 and being a poor metabolizer meant that I built up a higher than normal blood concentration of it, so was “overdosed”).