Info on medical use of the Midazolam + Fentanyl combo

[Cartesia]

OK so I've had 2 sets of endoscopys (and other-end-oscopys ) ... going for another lot soon.

both times they administered a combo (IV) of fentanyl + midazolam.

From what I understand the midazolam is used not just as a sedative but to blank your memory. Opiates I'm all too familiar with on their own, but again - not from an anaesthetists perspective.

Can someone just explain what drugs are performing what functions in the anaesthetic process - also which functions arise out of the combination, what the fentanyl is used for, what level of sedation I'm actually at - am I unconscious or am I just completely out of it and unable to remember afterwards? Which do they administer first - or is there any set order?

I understand they can use just midazolam to achieve a similar effect, but patient 'tolerance' of procedures is better with the combo? (by tolerance I'm not even sure what they're referring to.. http://www.ncbi.nlm.nih.gov/pubmed/19726793 )

All I can really report from memory is I lose consciousness in about a second - during which all the lights blur and take on a kind of shimmery overexposed appearance, and wake up feeling pretty nice, in a very subtle way.... one time they brought me out halfway through the procedure for a second but I didnt have time to take note of how I felt.

I'd love to be able to chat to the anaesthetist about it, but 1) They're always in a terrible rush/running late, 2) I dont want to set off any flags.

Now my limited experience with anaesthetists tells me that a fair few most likely be pretty interested in talking about such things, even on a personal experience level... but.... again, not wanting to trigger any negative reactions.

 

[sekio]

It's a combination one-two punch. You're left in a barely concious state, probably responding to commands but not "thinking". Kind of a twilight sleep. The actual depth of unconciousness can be fairly easily controlled because the 2 drugs have a fairly short half life.

Fentanyl will actually produce unconciousness if you dose high enough, but it is used mostly for the painkilling effect. The midazolam does the actual heavy lifting of making your memory fogged out and placid enough for people to stick plumbing snakes up your butt. It's also a fairly good muscle relaxant.

As one might expect, combining a benzodiazepine and an opioid is more effective than doses of either one on their own. the combination of the two allows unconciousness without too many after-effects caused by overloading of narcotics, like nausea and confusion.

Midazolam is also used on its own as a preoperative sedative/relaxant, without fentanyl, for slightly less invasive procedures like wisdom tooth extraction.

 

[Cartesia]

Thanks!

 

[danharper01]

I don't think he mentioned that combing too extremely strong depressant is a terrible idea.

 

[NeighborhoodThreat]

When they are administered in a controlled medical environment by a trained anesthesiologist it is another story, however. Don't try this at home, kids.

 

[sekio]

NT is right. Combining depressants is quite dangerous, but in a hospital/clinical setting you are monitored for heart/repiratory rate and depth of conciousness by a trained professional, who who knows what to do in "bad situations' and is almost always equipped with some Narcan and flumazenil..

 

[Cartesia]

Don't look at me, if I had fentanyl there's no way Id waste the experience by mixing it with anything!
But yes. Don't do this at home indeed.

Unfortunately I just found out that because I'm no longer covered by private health insurance, I will most likely only be getting some kinda benzo for my next procedure.. Apparently the public health system doesn't think getting a camera-pipe up the butt warrants paying an anaesthetist to remove the experience from your mind.

 

[limonov]

Don't look at me, if I had fentanyl there's no way Id waste the experience by mixing it with anything!
But yes. Don't do this at home indeed.

Unfortunately I just found out that because I'm no longer covered by private health insurance, I will most likely only be getting some kinda benzo for my next procedure.. Apparently the public health system doesn't think getting a camera-pipe up the butt warrants paying an anaesthetist to remove the experience from your mind.

If it makes you feel better, I've abused both the likely candidates for your procedure:

Propofol- I IV 10mg of this shit- it looks like fucking milk and holy shit, it fucking BURNS. Not just going it, it burns up my arm, into my shoulder, in to my chest (you'll get lidocaine, so fear not). I felt fucking amazing for about...8 minutes, then I black out/fell asleep for 8 hours.

Midazolam- When I had no tolerance to benzos I IV 15mg of midazolam (vials), felt FANTASTIC- ranted about some girl I wanted to fuck to myself, accidently texted my girlfriend instead of my mistress, then blacked out about 25 minutes later for a good 12 hours.

I'm pretty sure you could performed whatever medical procedure you wanted when I was under. I'm probably lcuky to still have my kidneys. You'll be fine man. Just don't start abusing benzos in the meantime. I was a lot more mobile on midazolam, even IV, once I got a big-fuck-off tolerance.

 

[Cartesia]

OK here's some info, some people might find this important.

I had the procedure. It was fucking horrible. I was waaay too with it.

They actually used the same combo (fent + midazolam) but because there was no anaesthetist, they kept me awake... They put more fent in me, but less midazolam.
Now thanks to my doctor misleading me "They just give you something like valium" (me presumes: benzo. likely the same one as last time) and my 8ish years of opiate abuse, the fentanyl didn't do shit. Well it did a little, but honestly I would've been better off taking a codeine CWE. I didn't feel opiate high at all. I think due to lack of anaethetist they were limited to 100mcg fentanyl, because if they'd pushed it higher I'm sure I would have been fine, and of all the patients that came out while i was waiting none had been given more than that.. heck when they knocked me out last time with an anaesthetist they only used 75mcg.

Cue throat pipe: Basically I was vomiting (nothing to vomit of course) the entire time.

Cue butt probe: I could feel it go around every turn, I could feel it blow everything around with air.... urgh I kept like looking up at them in distress trying to get them to kick things up a bit, but nothing.

Result: Probably gotta do the whole thing again with anaesthetist anyway. siiiiigh.