Stathis writes > I have not undergone conscious sedation myself, but I have administered the > anaesthetic (midazolam, diazepam, propofol, fentanyl) for hundreds of > gastroscopies and colonoscopies...
> 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 that is, I understand, for its anesthetic (pain-relieving) abilities > 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. I'm heartened to hear this, but am unconvinced. It is just as I worried about from the beginning: the philosophic consequences are debatable enough that some doctors are bound to suppose that if the patient doesn't remember it, then it doesn't matter. That attitude must be identified, abhorred, and stridently criticized whenever it is encountered. > 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. Yes, and given that it is *certain* that the pain cannot be avoided, then it probably is better for any patient to not remember it. (The only qualification to that is under what circumstances it is justifiable to deny information to an adult.) But here again, I strongly suspect that from the physicians' view, a desired state of the children has already been achieved: they're easier to handle and don't complain. How can this but fail to lessen the search for more effective anesthetics? Lee
