Bad experience with propofol

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Nords
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Re: Bad experience with propofol

Postby Nords » Sat Dec 28, 2019 10:34 am

slacker wrote:Current guidelines from the US Preventive Task Force support stopping colonoscopies at age 75, although the website shows that they are in process of reviewing the recommendations. I'm with you, Nords, and would give some thought about skipping the age 75 colonoscopy if the age 65 one is normal. Especially if you don't have a parent or sibling with colon cancer.

Yep. I get flagged for my father's prostate cancer and for a carcinoid on my appendix (which has been removed). These concerns might be based out of due-diligence legal concerns as well as medical concerns.

But hey, I get a free prostate video exam with every colonoscopy, and I get to be blissfully unaware during those exams.
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Re: Bad experience with propofol

Postby emmabarton » Sat Dec 28, 2019 11:23 am

Short&Right wrote:I've really been enjoying this site recently and figured this might be my one opportunity to contribute something here, as I'm an anesthesiologist. Propofol is probably the most commonly used drug in all of anesthesia. It is quite versatile and can be used for anything from light "conscious sedation" to general anesthesia. When used for sedation for procedures like colonoscopies it is very much a "titrate to effect" kind of drug, i.e. one person might be adequately sedated at dose x, but a 2nd person may require 1.5x for the same effect. It is very rapidly acting and we constantly adjust the dose to achieve the desired degree of sedation. It also typically wears off very quickly which is why it is so popular for quick procedures like a colonoscopy. One thing to keep in mind is that it is used as a continuous infusion for procedures like this so the longer the procedure the higher the total dose. So comparing total doses between procedures has very limited value.

There are definitely drug interactions between propofol, gabapentin, and clonazepam. Sedatives like clonazepam(and all other benzodiazepines) have an additive effect with propofol reducing the dose needed for a given effect. In fact we often deliberately take advantage of these interactions so there is nothing inherently dangerous about this combination.

It is difficult to know exactly what caused the OPs negative experience. But if I were to hazard a guess it was probably some combination of sleep deprivation, dehydration from the colon prep, and interactions with the different drugs used. The mental state prior to sedation probably does have some bearing on emotionality with emergence from anesthesia but for obvious reasons this is a little difficult to study accurately.


Hi Short&Right-- thanks so much for sharing some of your insight on this subject and for ultimately deciding to contribute! The ApoE4.info site is so rich with valuable information because of the contributions that professionals like yourself offer. Welcome to the community! I'm hopeful you'll continue to connect and share.

Not sure if you've familiarized yourself with the site, but we typically direct new contributors to the primer, which offers a lovely overview of the science of ApoE4 and other preventative details written by Stavia (another member physician who is homozygous for the ApoE4 allele). I'm a big fan of the wiki page because it is chocked full of really useful facts that are often missed by other search engines. Lastly, if you are inclined please feel free to introduce yourself and share a little about your own journey.

With hope for health and prosperity in the new year!

Emma
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TheBrain
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Re: Bad experience with propofol

Postby TheBrain » Sat Dec 28, 2019 3:15 pm

Wow. Thank you Circular, Slacker, Nords, Tincup, Short&Right, and Emma for your responses. I'm blown away by how helpful they and you are.

Short& Right, it's good to know that there's nothing inherently dangerous about the combination of propofol, gabapentin, and clonazepam and that these other meds can actually reduce the dose of propofol needed. Next time, I'll talk directly to the anesthesiologist about what I'm taking. I passed that information along to the lower-level staff and wonder if it got lost amongst the long list of supplements I take. And I definitely was sleep deprived and dehydrated and am convinced that suppressing my fear of colon cancer factored into my negative experience.

Again, thank you all!
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!

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Re: Bad experience with propofol

Postby PBW » Sun Dec 29, 2019 11:24 am

Thank you for your explanation of Propofol. I have had 2 colonoscopies both without anesthesia and no problems. I can not take opioids at all. They do not relieve pain take forever to leave my system and leave me in bad shape with the inability to hold down even water. So last year when I had an appendectomy the anesthesiologists really listened and avoided use of any opiod derivative and I think must have used propofol as general anesthesia. He said I never showed any signs of being in pain so he did not have to intervene within other anesthesia or medications other than adding an antibiotic as the appendix had begun to rupture. Does this all make sense to you.

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Re: Bad experience with propofol

Postby karelena » Sun Jan 05, 2020 2:43 am

TheBrain wrote:Does this suggest I shouldn't use this drug again? Might I have been overmedicated? Or is this saying something about the state of my brain? Of course, I can't help but wonder if my ApoE4 status is partly responsible for what happened.


As a pediatric intensivist I sedate children and adolescents almost every day for procedures, usually with a combination of versed (midazolam), ketamine and propofol. The dose ranges I use are for "deep sedation" which is a type of general anesthesia and my patients are not conscious during their procedures.

I can tell you that emergence from anesthesia is extremely variable. Typically my patients are awake within 30 minutes of the last propofol dose, but sometimes it is shorter or longer. Sometimes they are emotional when they emerge (called "emergence dysphoria"). Usually if they are crying before the sedation they are also upset when they wake up (and I have seen the same for the kids who go to sleep laughing and wake up the same way).

I do not think your experience was likely related to ApoE4 or the state of your brain. I agree with all the previous comments that the effects of the gabapentin, clonazepam, sleep deprivation and worry contributed to your experience. I also think perhaps they tried to wake you up too soon. In the future you could ask for an anxiolytic such as versed as a pre-med. Let them know that you are taking gabapentin and clonazepam (which can be sedating) and that you may be slow to wake up from anesthesia.

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TheBrain
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Re: Bad experience with propofol

Postby TheBrain » Sun Jan 05, 2020 5:14 pm

karelena wrote:
TheBrain wrote:Does this suggest I shouldn't use this drug again? Might I have been overmedicated? Or is this saying something about the state of my brain? Of course, I can't help but wonder if my ApoE4 status is partly responsible for what happened.


As a pediatric intensivist I sedate children and adolescents almost every day for procedures, usually with a combination of versed (midazolam), ketamine and propofol. The dose ranges I use are for "deep sedation" which is a type of general anesthesia and my patients are not conscious during their procedures.

I can tell you that emergence from anesthesia is extremely variable. Typically my patients are awake within 30 minutes of the last propofol dose, but sometimes it is shorter or longer. Sometimes they are emotional when they emerge (called "emergence dysphoria"). Usually if they are crying before the sedation they are also upset when they wake up (and I have seen the same for the kids who go to sleep laughing and wake up the same way).

I do not think your experience was likely related to ApoE4 or the state of your brain. I agree with all the previous comments that the effects of the gabapentin, clonazepam, sleep deprivation and worry contributed to your experience. I also think perhaps they tried to wake you up too soon. In the future you could ask for an anxiolytic such as versed as a pre-med. Let them know that you are taking gabapentin and clonazepam (which can be sedating) and that you may be slow to wake up from anesthesia.


karelena, thanks for sharing your expertise and experience with this matter. I definitely feel reassured, and I’ll follow your advice the next time the opportunity arises. That will hopefully be years away, but I’m certain I won’t forget your advice, despite the passage of time. :)
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!


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