Viewing 31 posts - 1 through 31 (of 31 total)
  • Propofol Vs Midazolam
  • flanagaj
    Free Member

    I have got to go and have an endoscopy and the reverse one and whilst I have had them done before they were all private last time as I had private health. When done private they always used Propofol and it’s basically like a general as I just remember it being administered and then the next was waking up in recovery.

    The NHS consultant said they use Midazolam on the NHS and was rather vague as to whether it knocks you out like Propofol.

    Does anyone one here know whether it does knock you out like Propofol or will I be awake, but just feeling drowsy?

    THanks

    qwerty
    Free Member

    Probably depends how much!

    Ketamine?

    P-Jay
    Free Member

    I had some surgery about 3 weeks ago.

    I was given lots of Midazolam, it’s a remarkable (to me me) drug. I’m an anxious person generally, I’ve had treatment for it, my anxiety was about 625 out of 10 at time. The 90 mins surgery was just reaching the 3 hour mark and the surgeon (bless her) had reached the “swearing and hitting it with hammer” stage we’ve all reached at some point in the workshop. Things were not going well.

    Anyway, they fired this Midazolam into me and it was like someone switched off a lifetime of anxiety in a moment. I’ve never felt so lucid and focused my whole life. Quietened down my mind was amazingly sharp. It was like that stuff in that film ‘limitless’.

    This might sound like I was off my nut, and now I’ve typed it out, it does seem that way, but as far as I can tell there was no high or buzz, I just relaxed, stopped feeling anxious like I haven’t felt for years, decades even was happy to let her bang away with the hammer.

    She said I would likely forget it all as it wore off, but I didn’t, they gave me a little ‘test’ and I could recall lots of small details of the procedure.

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    WorldClassAccident
    Free Member

    there was no high or buzz, I just relaxed, stopped feeling anxious like I haven’t felt for years, decades even was happy Adds that to my shopping list

    flanagaj
    Free Member

    @P-Jay : thanks. Sounds interesting. Propofol means you don’t remember anything so it would seem it is a very different drug. I am intrigued about the anti anxiety aspect of it now.

    tjagain
    Full Member

    I had midazolam and fentayl for my colonosocpy. At the time i thought I was awake the whole time but in hindsight I clearly was not properly aware. It is known for producing amnesia so you don’t remember everything and while its in your system live only in that minute

    Its damn good stuff midazolam and IMO propofol is OTT for a colonoscopy. My bet the private use it simply because they can charge more as you will need more after care

    MoreCashThanDash
    Full Member

    there was no high or buzz, I just relaxed, stopped feeling anxious like I haven’t felt for years,

    Do you have to have a medical procedure to try this stuff? Sounds just what I need….

    flanagaj
    Free Member

    @tjagain – Would you have any qualms about having an endoscopy under Midazolam?

    You are probably correct regarding private hospitals using Propofol as it requires an anesthetist to be present, but I did make it clear that having had an endoscopy once before with just a throat spray and a colonoscopy with nothing (never again to both) that I didn’t want a similar experience.

    flanagaj
    Free Member

    Do you have to have a medical procedure to try this stuff? Sounds just what I need…

    Not sure it beats the dropping off feeling you get from Propofol. I can see why Michael Jackson got hooked on it!

    tjagain
    Full Member

    Would you have any qualms about having an endoscopy under Midazolam?

    Non at all. I did also have fentanyl which is a strong opiate and told the doc that I was terrified so give me loads ( dunno if he did). NO pain. no embarrasment, and I really did not give a shit!

    devash
    Free Member

    Any reason why you’re being offered such strong anaesthetics / sedatives for the endoscopy?

    I can’t speak for the colonoscopy but I’ve had two endoscopies in the past due to acid reflux and both times they were done while I was fully awake without any sedatives at all. They only offered me a numbing throat spray to stop the gagging. These were done on the NHS and as you can imagine both times were effing horrible experiences!

    flanagaj
    Free Member

    Any reason why you’re being offered such strong anaesthetics / sedatives for the endoscopy?

    I can’t speak for the colonoscopy but I’ve had two endoscopies in the past due to acid reflux and both times they were done while I was fully awake without any sedatives at all. They only offered me a numbing throat spray to stop the gagging. These were done on the NHS and as you can imagine both times were effing horrible experiences!

    I stated to the consultant that I had a bad experience before when no pain relief / sedative was used. I know some people are happy to have an endoscopy with just the throat spray, but they are hardcore.

    tjagain
    Full Member

    For me – there is no way I could have had the colonoscopy without. My psychological makeup.

    P-Jay
    Free Member

    Do you have to have a medical procedure to try this stuff? Sounds just what I need….

    Well, you need a prescription. But it’s prescribed in tablet form for anxiety and sleeplessness I think. You could ask your GP but opening with “yeah, Geezer on the web says it’s great” might cause a red flag or two.

    There are certain drugs you can buy online with a ‘online consultancy’ which is little more than a multiple choice test. You could probably get some if you really want

    Frankly it’s not hard to work out the usual dose for prescriptions either.

    Word of warning though, I don’t know if it was the Midazolam, the nerve block drug or the other pain meds they had to pump into me when it went over time, but my BP plummeted towards the end and I had to spend an hour laying on a tilt with my legs in the air before I passed out ha ha.

    I’d try some more of it though if I had the chance, I’m sure I’d have telekinesis in a week. 😉

    flanagaj
    Free Member

    I’d try some more of it though if I had the chance

    That’s my weekend sorted. Online pharmacy here I go.

    tjagain
    Full Member

    Do you have to have a medical procedure to try this stuff? Sounds just what I need….

    Its a very powerful benzodiazipine. ( same family as Valium but shorter acting and much more powerful) Its not a drug to be messed with in any way shape or form and I very much doubt any GP would give a prescription except in complete extreme situations

    Benzodiazipines are extremely addictive, withdrawal can be fatal, they have horrendous side effects when used for anything other than short term.

    dms01
    Full Member

    I have provided sedation (for dentistry), for more than 25 yrs and the techniques used for endoscopy are very similar / copied from those originally developed by our profession for the nasty stuff we end up having to do.

    Both propofol and midazolam can be used as anaesthetic agents or for sedation, though the margin of safety for sedation is greater for midazolam than propofol, at least for an ‘operator sedationist’ model of care. I.e. it’s easier to inadvertently give you too much using propofol than it is with midazolam. Knocking you out is a BAD thing in this context, so if using propofol you need someone just for the sedation and a second operator for the procedure. With midazolam it can safely be performed by a single operator with nursing support.

    In an outpatient context midazolam is probably a better option for most cases. Propofol requires a higher level of training for the sedationist, more kit (infusion pumps), and whilst recovery is slightly faster (discharge is not), amnesiac and anxiety reduction are about the same. Adding in additional opioids increases the complexity of the procedure and the risk of complications such as respiratory depression. It’s also unnecessary as single agent midazolam work just as well and is safer.

    What really matters in terms of safety and ‘the experience’ is how well the team have been trained and how how carefully you are monitored in recovery. Either will provide anxiety reduction and and amnesia in about 80%.

    tjagain
    Full Member

    Its also a schedule 3 CD IIRC which means its more tightly controlled than most drugs.

    Royston
    Free Member

    I had a Colonoscopy, yesterday as it happens. Awake whilst being given IV Midazolam, next thing I know is I’m waking up in recovery all done and dusted. Given photo’s of my Colon to take home. The only thing that was specified was that I shouldn’t drive for 12 hours so O/H came and picked me up.
    My Dad had at least four at various times beyond 55 and had them all under Midazolam
    I’m a Nurse (granted not in Adult Medicine) and I was only ever aware of the use of Midazolam for the procedure

    flanagaj
    Free Member

    What really matters in terms of safety and ‘the experience’ is how well the team have been trained and how how carefully you are monitored in recovery

    That’s the impression I get. The internet is awash with stories of people saying they were given Midazolam and it did absolutely nothing. At least when you have an Anesthetist performing the sedation you know he’s going to be keeping you right in the twilight zone.

    Awake whilst being given IV Midazolam, next thing I know is I’m waking up in recovery all done and dusted.

    That’s how it should be.

    dms01
    Full Member

    Though in truth that’s the amnesic properties… not that you were actually asleep… I have regular ‘discussions’ explaining to patients that last time they were not actually asleep… it just feels that way.

    tjagain
    Full Member

    I was certainly awake and aware – I just didn’t care one jot and also afterwards have a couple of minutes of memories for a procedure and recovery that took an hour

    tommyo
    Full Member

    I’m a consultant anaesthetist. Both midazolam and propofol are dangerous drugs but very effective when used in experienced hands. It takes 14yrs minimum to train from medical school to consultant anaesthetist for a reason. Not something to mess with or ask for a prescription as they have no role in chronic use.

    Effective sedation is what the OP wants. Both drugs can provide this which is why both are used commonly.

    The effect of each is dependent on many factors. Simply put, alcohol can be used as a drug to sedate for such procedures, it is a very effective hypnotic, but has the slight issue of the lethal dose being very close to the effective dose for sedation…

    The descriptions folk are using to describe the different effects, think about the first time you got properly drunk and how you felt.. Everyone probably would come up with a different description?

    I suggest dictating to the people in the hospital what drugs they must use to keep you safe during the procedure is unwise, as what you want is them to use what they are most familiar using and use effectively?

    I’d be happy to have either.

    docrobster
    Free Member

    I’ve had a few GAs but never asked what they were giving me. Trust them to do their job etc.
    However we use midazolam in palliative care and it seems to be very good at relieving agitation. All the MacMillan nurses I’ve ever worked with have liked it and said that they would want it when their time comes!

    tjagain
    Full Member

    I agree Doc. I have used midazolam in end of life care and would want it myself

    Mind you I also want Bromptoms cocktail while I can still swallow if any of you are old enough to know what that is. 🙂

    clarkpm4242
    Free Member

    I had a Colonoscopy, yesterday as it happens. Awake whilst being given IV Midazolam, next thing I know is I’m waking up in recovery all done and dusted. Given photo’s of my Colon to take home. The only thing that was specified was that I shouldn’t drive for 12 hours so O/H came and picked me up.

    Had 2 colonoscopies recently. First with Midazolam. A real pain not driving for n hours after. Second just gas and air. Made sure I got in a good few pre-emptive tokes and it was just fine. Able to drive home 30 mins later.

    andyecc
    Free Member

    As a medic and also as a frequent recipient of endoscopies due to my Crohn’s disease I have a fair bit of useful experience.
    There are several drugs that can be very helpful. They’re all effective but need a well trained practitioner administering them.
    I have had several scopes that were unpleasant without adequate sedation. I now make sure that whoever is doing the scope knows this and is prepared to manage it appropriately. I’ve also had uneventful scopes with minimal sedation. The most important factor is the skill and empathy of the endoscopy team.
    Letting the team know your anxieties and wishes for treatment are important. Good endoscopy teams will listen to that and act accordingly.

    tjagain
    Full Member

    Letting the team know your anxieties and wishes for treatment are important. Good endoscopy teams will listen to that and act accordingly.

    I told the folk doing mine I was shitting myself literally and metaphorically

    scaredypants
    Full Member

    I’ve had a few GAs but never asked what they were giving me. Trust them to do their job etc.

    I had a good chat with the anaesthetist at my last most recent hernia repair. Asked him to tell me what he was giving me and when, so I could note what it was like (professional interest, yer honour 😉 )

    So he did. Warmed up with a spot of midazolam, then Fentanyl, then propofol.

    And I can’t remember any of it at all except feeling that it was mighty fast when it finally happened

    docrobster
    Free Member

    I know some people are happy to have an endoscopy with just the throat spray, but they are hardcore.

    I’m not at all hardcore, but…
    I’ve only had a upper gi endoscopy once. I was jr dr on a gastro ward. It was after Christmas and I was probably complaining about indigestion. My boss picked up on this and asked me about it. Don’t know whether it was my family history of stomach cancer (dad died aged 47) that made his mind up or he just wanted some practice but he added me to the morning list for upper gi endoscopy. Cannula in. Squirt to the back of the throat. Quick look. Ok you’re fine now go and finish the ward round…
    I was 25 though.
    Worst bit was the taste of the throat spray…

    slowoldman
    Full Member

    I had a colonoscopy privately a few years ago. No idea what was used but I watched it on the big screen and didn’t feel a thing.

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