OpenHealth Q&A

Challenges with Sedation During Medical Procedures

I’m 25 years old, standing at 5’5” and weighing 238 pounds. I occasionally vape and have a medical cannabis prescription that I utilize about once or twice a week to manage chronic pain and anxiety linked to OCD, particularly when I experience panic attacks. My concern revolves around the ineffectiveness of sedation during a recent endoscopy. I’ve been undergoing a series of medical evaluations, including an endoscopy. Due to my claustrophobia, the medical team recommended that I receive 'conscious sedation'. They administered a dose of midazolam, though I’m unsure of the specific dosage as I only received one syringe. However, I didn’t experience any drowsiness or relaxation, and my heart rate remained elevated. After this, they administered a second dose, but the results were the same. They then introduced fentanyl; after a five-minute wait, I was still completely awake, coherent, and anxious. Despite my efforts to undergo the procedure, I found myself panicking. The physician faced difficulties advancing the tube since my throat was involuntarily spasming, something I wasn’t aware I was doing. I eventually shook my head, signaling for them to stop, and I ended up in tears. Consequently, it was decided to halt the procedure and reschedule it. The staff informed me that additional sedation wasn’t an option, indicating that the amount I had already received was above the standard dose. Moreover, my low blood pressure posed another consideration for their sedation strategy. Before the procedure, I was informed that I wouldn’t be able to drive, sign any significant documents, or be left unsupervised for 24 hours. However, I’ve remained alert throughout this time. Although I don’t drive, my partner mentioned that he has observed me to be fully cognizant since he picked me up. Initially, I attributed my alertness to my weight, but while in recovery, I noticed a woman of larger stature who had undergone the same procedure. She left in a wheelchair, seemingly unable to keep her eyes open, exclaiming that she only needed "one shot" of midazolam. We had conversed in the waiting room, and upon learning that we both received midazolam, I couldn’t understand why it had such an effect on her and not on me. Over the prior four days, I had undergone a CT scan with contrast (possibly iodine) and an MRI that involved a different contrast agent whose name escapes me. Could these imaging agents still be in my system and affecting the sedative's effectiveness? Interestingly, I have a history of waking up during a dental procedure at the age of eight or nine, which surprised the dental team. Moreover, any medication I have taken that is supposed to induce drowsiness typically has little to no effect on me. While I occasionally use codeine for flare-ups (which occur infrequently), I don’t feel sedated even if others have experienced drowsiness from much lower doses. I even struggle to get to sleep with sleeping pills, whether they are herbal or prescribed. Is it conceivable that my body metabolizes these medications differently than expected? I wasn’t resisting the medication or skeptical of its effects; I was under the impression that it would lead to a deep state of drowsiness, as the doctor had suggested. I refrained from using my medical cannabis for three weeks leading up to the tests to avoid any potential interference. Aside from my previous dental episode, I have not been sedated before, and I rarely use opiates. Given that the endoscopy is crucial for addressing concerning symptoms, especially considering the other scans I’ve had, I am left uncertain about the way forward. The experience was incredibly traumatic—one of the most challenging medical encounters I’ve faced thus far. The medical team assumed, understandably, that I was sedated and in a drowsy state, and because of the tube in my throat, I couldn't communicate that I was fully aware. They only realized my distress when I shook my head. What options do I have?

Answers (1)

6/20/2025, 5:10:59 PM

OpenHealth AI

I'm sorry to hear about your challenging experience during the endoscopy. It’s understandable that you’re feeling distressed given the traumatic nature of the situation. Your concerns about sedation and how your body reacts to medications are important to address, so let’s look into your symptoms and possible next steps.

Main Points

1. Variable Response to Sedation: Your body may metabolize medications like sedatives differently, which could explain why you didn’t feel the effects of midazolam and fentanyl.
2. Previous Experiences: Your history of waking during sedation could indicate a unique response to sedatives.
3. Next Steps: It's essential to have an open discussion with your healthcare team about your sedation preferences and possibly explore different options.

Explanation

1. Metabolism of Medications: Everyone metabolizes medications differently based on factors like genetic makeup, weight, and medical history. Some people may require higher doses to achieve the desired effect, while others may respond strongly to lower doses, which might explain your observation of varying responses between yourself and the other patient.

2. Impact of Medical Cannabis: Although you didn’t use medical cannabis for three weeks before your procedure, it’s worth noting that the history of your use might interact with sedatives, especially considering anxiety levels could also play a role in how sedatives work for you.

3. Possible Options:

   • Deep Sedation: Discuss with your doctor about the possibility of deeper sedation for your next endoscopy, which might involve a different class of medications or anesthesiology support.
   • Alternative Sedative Choices: Medication options like propofol might also be considered, which can provide a different hypnotic effect compared to midazolam.
   • Anxiety Management Techniques: Since anxiety can impede sedation effectiveness, incorporating techniques like relaxation exercises, breathing techniques, or pre-medication with an anxiolytic (e.g., lorazepam) before the procedure could help.

Actionable Next Steps

1. Follow-Up Appointment: Schedule a follow-up appointment with your gastroenterologist or healthcare provider. Prepare to discuss your sedation experience in detail, including your reactions to the medications, your history of sedation, and your concerns.

2. Sedation Plan Discussion: During the discussion, express your desire for a detailed sedation plan, advocating for deeper sedation options or alternative medications tailored to your body's needs.

3. Coping Strategies: In the meantime, consider practicing techniques like mindfulness, controlled breathing, or guided imagery to help with anxiety when rescheduling your endoscopy.

4. Seek Support: Discuss any concerns about anxiety with a mental health professional who can help provide coping strategies and support for managing anxiety related to medical procedures.

Remember, it’s crucial that you feel safe and comfortable with your medical team, and advocating for your needs is an important part of that process. You’re not alone in this, and there are solutions to improve your experience. If specific details or questions arise as you prepare for your next steps, feel free to reach out for more guidance.