Bad experience with propofol

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TheBrain
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Bad experience with propofol

Postby TheBrain » Sat Dec 21, 2019 2:30 pm

Is propofol a type of general anesthesia? I've been thinking it's not. I did some poking around on the forum and elsewhere, and it's unclear to me.

Yesterday, I had a colonoscopy. Propofol was used to sedate me (or whatever this drug does). After the colonoscopy, I was taken to a small recovery room and my husband, Tim, was brought in. The nurse had difficulty waking me up. She'd frequently come into the room, shake my shoulders, say my name and a few words, and I wouldn't wake up. Tim said she was trying to not act concerned, but he could tell she was. So he then got concerned. His guess is that it took at least 20 minutes longer than expected for me to "wake up."

But when I "woke up," I was incoherent and mostly kept my eyes closed. Tim could understand a few words I said, like the name of my sister "Valerie," "SIBO" (which I was diagnosed with last year), and "cancer." I was in a state of fear and agitation. He tried to calm me down, repeatedly saying "Everything's fine. The doctor said your colon is normal. Nothing's wrong. Open your eyes. It's time to go home." This went on for at least 10 minutes. He was scared.

I then came out of this state and thought I just woke up at that moment. I have no recollection of saying anything or of feeling any fear.

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.

My paperwork says I was given "Propofol 400 mg IV."

I should add that I took 200 mg Gabapentin at bedtime the night before for my insomnia. When I awoke around 3 a.m. to go to the bathroom, I took 1.5 mg clonazepam to help me get back to sleep. I had to wake up at 5 a.m. to complete my colonoscopy prep. Needless to say, I didn't get enough sleep that night (or the night before).

I take Gabapentin 3-4 nights a week (not every night because I'd develop a tolerance for it). I take clonazepam every night when I wake up to go to the bathroom. I told the staff about this prior to my procedure.

I can see now that leading up to this colonoscopy, I hadn't been acknowledging a fear I had of this procedure revealing I had precancerous polyps or colon cancer. My sister Valerie has twice had precancerous polyps removed during colonoscopies (three polyps in all). She's 18 months younger than me and smoked cigarettes much longer than I did. (I quit at age 22. I'm 59 now.) In the past month or two, I heard in a podcast that untreated SIBO (small intestine bacterial overgrowth) can lead to cancer (although colon cancer wasn't specifically mentioned). My SIBO was undiagnosed for many years, maybe even decades. So it appears that all theses thoughts were running around in my head and then vocalized before I was truly awake.
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Re: Bad experience with propofol

Postby circular » Sat Dec 21, 2019 6:40 pm

This is a bit ironic and hopefully helpful. I also took my father for a procedure yesterday where they used propofol. He is elderly and e3/4 and possibly beginning to experience some mild cognitive impairment. They only needed him really out for 15 minutes, so his dose may have been less than yours. He rebounded quickly without a trace of an effect. He had 300 mg gabapentin with evening meds the night before.

Perhaps noteworthy is that there was a very long delay before his procedure. A person before him had complications and eventually went out with EMTs on a stretcher. It turned out he had taken a medicine they think did not go well in his body with his anesthesia. I have reason to believe he also had propofol. When I heard this I was concerned because dad had taken his morning meds as directed and no one indicated that was a problem. When I double checked with the anesthesiologist he said ‘not usually’ and it was clear he’d just seen an exception.

So, you know I’m not trained in all this, but maybe the clonapin was enough to interact with the propofol. I would not be at all surprised. I think it has a fairly long half life. I use it rarely if my stress level goes into the stratosphere and can only tolerate 1/4 of the smallest dose pill. 1/4 dose like that gets me back on track for many months. A whole clonapin pill sedated me for two days.

Absent a more educated opinion my money is in the clonapin + propofol not being a great combo, but that doesn’t leave out the possibility that you are just more sensitive to propofol at the dose given.

I’ll be interested in others’ thoughts, since I think propofol is supposed to be a friendlier sedation drug for us than most?
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Re: Bad experience with propofol

Postby slacker » Sun Dec 22, 2019 9:53 am

Here's a link to possible drug interactions of propofol and klonopin. Propofol is used for "conscious sedation" during procedures like a colonoscopy so that the person doesn't really know what is going on. If you need propofol in the future, it might be worth discussing what happened to you with the anesthesiologist. It's tricky balance between not enough and too much.
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Re: Bad experience with propofol

Postby TheBrain » Sun Dec 22, 2019 11:26 am

circular wrote:This is a bit ironic and hopefully helpful. I also took my father for a procedure yesterday where they used propofol. He is elderly and e3/4 and possibly beginning to experience some mild cognitive impairment. They only needed him really out for 15 minutes, so his dose may have been less than yours. He rebounded quickly without a trace of an effect. He had 300 mg gabapentin with evening meds the night before.


Thanks, Circular. Your experience with your dad is certainly timely and definitely helpful. It's too bad about that other person. I hope he's okay.

When I first staring using clonazepam in 2003, I took 1 mg at bedtime. It was like a miracle drug. I slept through the night, with the exception of waking up once briefly to use the bathroom. Of course, tolerance has built up over time, but there was a long stretch where I only used 1/4 mg at bedtime a couple days a week and then I slowly weaned off of it altogether and went about 10 months without it. Of course, I'd like to get off of it entirely, but I don't see that coming any time soon based on how I've been sleeping lately.

It's amazing to me that a 1/4 dose gets you back on track for months. I wish!

slacker wrote:Here's a link to possible drug interactions of propofol and klonopin. Propofol is used for "conscious sedation" during procedures like a colonoscopy so that the person doesn't really know what is going on. If you need propofol in the future, it might be worth discussing what happened to you with the anesthesiologist. It's tricky balance between not enough and too much.


Thanks, Slacker. Between what Circular wrote and what you've written here, I'm very suspicious of the combination of propofol and klonopin due to possible drug interactions. I suspect that between the two, I was over-sedated. (And I also suspect I had a nightmare for which I was partly awake.)

Great idea to discuss what happened to me with the anesthesiologist the next time propofol is suggested. And it's good to know this drug is used for "conscious sedation." That sounds a lot better than general anesthesia.
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Re: Bad experience with propofol

Postby circular » Sun Dec 22, 2019 11:38 am

TheBrain wrote:
circular wrote:This is a bit ironic and hopefully helpful. I also took my father for a procedure yesterday where they used propofol. He is elderly and e3/4 and possibly beginning to experience some mild cognitive impairment. They only needed him really out for 15 minutes, so his dose may have been less than yours. He rebounded quickly without a trace of an effect. He had 300 mg gabapentin with evening meds the night before.


Thanks, Circular. Your experience with your dad is certainly timely and definitely helpful. It's too bad about that other person. I hope he's okay.

When I first staring using clonazepam in 2003, I took 1 mg at bedtime. It was like a miracle drug. I slept through the night, with the exception of waking up once briefly to use the bathroom. Of course, tolerance has built up over time, but there was a long stretch where I only used 1/4 mg at bedtime a couple days a week and then I slowly weaned off of it altogether and went about 10 months without it. Of course, I'd like to get off of it entirely, but I don't see that coming any time soon based on how I've been sleeping lately.

It's amazing to me that a 1/4 dose gets you back on track for months. I wish!

Well that's not to say that I'm not often very stressed and at times to the point it affects my sleep, but I usually use other means to manage it and reserve the 1/4 dose clonapin for the most extreme scenarios. So 'back on my track' isn't necessarily desirable :lol: As I always question, some day external conditions will calm down? :roll:
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Re: Bad experience with propofol

Postby TheBrain » Sun Dec 22, 2019 11:58 am

circular wrote:Well that's not to say that I'm not often very stressed and at times to the point it affects my sleep, but I usually use other means to manage it and reserve the 1/4 dose clonapin for the most extreme scenarios. So 'back on my track' isn't necessarily desirable :lol: As I always question, some day external conditions will calm down? :roll:


Well, it's great that you have other means that help you manage your sleep issues. My "other means" don't work. So good for you.

Yes, some day, your external conditions will calm down. Hang in there.
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Re: Bad experience with propofol

Postby Nords » Fri Dec 27, 2019 7:47 pm

TheBrain wrote:My sister Valerie has twice had precancerous polyps removed during colonoscopies (three polyps in all). She's 18 months younger than me and smoked cigarettes much longer than I did. (I quit at age 22. I'm 59 now.) In the past month or two, I heard in a podcast that untreated SIBO (small intestine bacterial overgrowth) can lead to cancer (although colon cancer wasn't specifically mentioned). My SIBO was undiagnosed for many years, maybe even decades. So it appears that all theses thoughts were running around in my head and then vocalized before I was truly awake.

Precancerous polyps are so commonly found during colonoscopies that doctors expect to remove one during just about every procedure. It's one of the reasons that they insist on doing the exam with the internal hardware instead of using the external scans of a virtual colonoscopy.

The trend may be more important than the polyp. I had one polyp removed on my 50-year-old colonoscopy, and it was considered precancerous. The doctor recommended another colonoscopy in five years. At the 55-year-old colonoscopy, no polyps were found and I was paroled for 10 years due to good behavior.

If there's nothing on my 65-year-old exam then I might just declare myself finished with that procedure... assuming Medicare decides it's even worth doing past that age.
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Re: Bad experience with propofol

Postby slacker » Sat Dec 28, 2019 5:27 am

Nords wrote:I had one polyp removed on my 50-year-old colonoscopy, and it was considered precancerous. The doctor recommended another colonoscopy in five years. At the 55-year-old colonoscopy, no polyps were found and I was paroled for 10 years due to good behavior.

If there's nothing on my 65-year-old exam then I might just declare myself finished with that procedure... assuming Medicare decides it's even worth doing past that age.


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.
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Re: Bad experience with propofol

Postby Tincup » Sat Dec 28, 2019 7:14 am

My aunt was diagnosed this year with stage 3 colon cancer at age 87. It was resected. Don't know her colonoscopy history. So can get colon cancer at later ages.

My wife and I did virtual colonoscopies 18 months ago, with no polyps. They said the statistics were that 20% of the scans would find polyps and therefore require a repeat with a hands-on procedure.

Propofol dosing is here. It was used during Theresa's stem cell procedure in July without issue. Don't know the dosage. The procedure did have some duration as they harvested stem cells from both her fat and bone marrow. An anesthesiologist was present to administer the med (one of our requirements). A friend who has had a number of electro-cardioversions says his dosage was 110 mg. He's 6'2", however the procedure is very short duration.
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Re: Bad experience with propofol

Postby Short&Right » Sat Dec 28, 2019 9:40 am

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.


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