I have not undergone conscious sedation myself, but I have administered the
anaesthetic (midazolam, diazepam, propofol, fentanyl) for hundreds of
gastroscopies and colonoscopies. Sometimes the patients are more or less
fast asleep for the whole experience. Other times, they seem to be fully
awake, talking to you with only a slight slurring of their voice, as if they
have had a few beers. In fact, benzodiazepines are not that dissimilar to
alcohol pharmacologically, and patients who go into delirium tremens from
alcohol withdrawl are treated with large doses of diazepam. (It is ironic
that any adult can buy as much alcoholic beverages as he wants, but for
diazepam, which basically has all the effects of alcohol but is much safer,
a prescription is needed.) The dose of the anaesthetic agent in conscious
sedation is titrated according to how the patient responds: if he is very
anxious the anaesthetist might give more midazolam, which is primarily given
for its anxiolytic effect rather to induce amnesia, while if he is
complaining of pain more fentanyl is given. Not everyone has complete
amnesia for the procedure afterwards, but even if amnesia were guaranteed,
certainly no doctor would deliberately allow a patient to suffer just
because he won't remember it. The only situation I can think of where
midazolam might be used primarily for its amnestic effect is with young
children (you squirt it up their nose!) who need to have a series of
unpleasant treatments, and would become very distressed each time if they
could remember the details of their last experience.
--Stathis Papaioannou
Jonathan Corgan wrote:
>Russell Standish wrote:
>
>>This leads to a speculation that memories are an essential requirement
>>for consciousness...
>
>I agree. Had I known then what I know now, I would have asked the nursing
>staff and doctor to question me in detail about my first person experience
>*while it was happening*, since all I can think about now is how I felt
>before and after.
>
>Was I oriented to time, place, who I was, and what was happening to me?
>
>Did my first person experience of consciousness "seem" any different?
>(Aside from the obvious mellowness that any sedative induces.)
>
>While I was undergoing the procedure, and feeling the pain, did I regret
>the decision to be "awake" but not remember later?
>
>Knowing that I would forget this, is there anything about what I was
>experiencing that I'd want to be noted so I could read about it afterward?
>
>etc.
>
>So I do wonder, if I was "awake" and responding accurately to verbal cues,
>but not "laying down memories", was I really conscious? Of course, it
>*seems* to me now that I was unconscious the whole time, with some odd
>"emergent effects" as the Versed wore off. But as I've gathered from
>reading folks like Dennett, what things seem like and what actually is
>happening can be very different things.
>
>Performing the question & answer session described above is at least part
>of my willingness to undergo conscious sedation again.
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Received on Sat Jul 02 2005 - 01:54:03 PDT