topic Re: I stand corrected! Joan Rivers procedure in Community Chat

I stand corrected! Joan Rivers procedure

scotttie — Mon, 08 Sep 2014 17:12:16 GMT

http://www.webmd.com/oral-health/laryngoscopy

Re: I stand corrected! Joan Rivers procedure

scotttie — Mon, 08 Sep 2014 17:14:12 GMT

I thought that sedation for the procedure Joan had was the same as endoscopy or colonoscopy.

Evidently, upon further research, what she had requires General Anasthesia.

The doctors have been talking about Propophol so perhaps that's what they used but this is not the same as the twilight sleep I have been talking about on several threads here.

Pitdakota. Come.

Re: I stand corrected! Joan Rivers procedure

LilacTree — Mon, 08 Sep 2014 17:27:45 GMT

I've had two laryngoscopies, both in the doctor's office with a local spray-like med that numbed my throat. I had them both with the flexible tubes that were threaded down my throat and had lights on the ends of them. They were mildly uncomfortable, but I didn't feel pain (I think it was a lidocaine spray similar to the injections one gets at a dentist's office, but instead of a needle, a spray is used), and I was totally awake. They were both exploratory and no tissue was taken. There were no other people (or machinery that I noticed) in the room but the doctor and me.

From what is described in the link, it appears that Joan may have had the "rigid" laryngoscopy and that is why she was anesthetized and totally put under.

As I've stated in other threads, I've had at least eight endoscopies, and those were done at an endoscopy center in a well equipped room, with several individuals, including the gastroenterologist who did the procedures, and an anesthesiologist present. My daughter tells me I was probably given Fentanyl, since I was not in a twilight sleep for those procedures, I was "out" and woke up as one does from general anesthesia. I just read on Google that fentanyl is 50-100 times more potent than morphine.

Re: I stand corrected! Joan Rivers procedure

scotttie — Mon, 08 Sep 2014 17:53:41 GMT

Since I have been using the term "twilight sleep" which is a term I am sure I learned from someone who is a nurse in this field; I decided to look it up in my dd's Taber's Cyclopedic Medical Dictionary (heh-heh I knew all this nursing school expense would pay off someday ).

Anyway, this is their definition of "twilight sleep":

"A state of partial anesthesia and hypoconsciousness in which pain sense has been greatly reduced by the injection of morphine and scopolamine. The patient responds to pain but afterward the memory of the pain is dulled or effaced. Although once in common use as a method of analgesia for childbirth and minor surgery, twilight sleep has been replaced by more effecite contemporary approaches to pain control. "

Therefore, my use of the term "twilight sleep" is evidently outdated.

Re: I stand corrected! Joan Rivers procedure

scotttie — Mon, 08 Sep 2014 17:55:27 GMT

PS: When I have had endoscopies or colonoscopies they used a combination of drugs. I believe they use versed and demerol but not sure. I am told that on one of my colonoscopies I woke up during but I don't remember it.

When dd had her bone marrow aspirations and biopsies they used a combination of Versed and Fentanyl.

Propophol is in use for these gastro procedures now too. That's what my friend has when she gets her tests.

Re: I stand corrected! Joan Rivers procedure

sgraham30 — Mon, 08 Sep 2014 18:22:45 GMT

I wonder if she might have been allergic to whatever anesthesia was used? My father had heart surgery years ago before he died & they nearly lost him because of an allergic reaction to whatever anesthesia was used during the surgery.

Re: I stand corrected! Joan Rivers procedure

pepes mom — Mon, 08 Sep 2014 18:43:47 GMT

Around here, Propofol is used for all sorts of -oscopies. It has become the standard in sedation. I've had Propofol for my last 3 procedures. Additional agents are also used, such as Fentanyl and Versed. Patients are seen by an anesthesiologist and the meds are administered by a CRNA.

Re: I stand corrected! Joan Rivers procedure

Shorty2U — Mon, 08 Sep 2014 18:44:53 GMT

I think we all have to wait and see what the results of Joan's autopsy show.

As I was told many times, one can be healthy and have all the tests in the world before a procedure, but anything can happen during it no matter how healthy one is. A person can even have a cardiogram or stress test today and can still fall over tomorrow. Those tests show what is going on "at the time" and cannot predict the next day.

As far as Propofol etc it is my understanding through having surgeries that they use a mix of drugs to put people to sleep. (I asked a lot of questions when I was to have Propofol and this is what they told me).

Joan has had a number of procedures so I'm sure (and would hope) that the Dr and or anesthesiologist went over what was used before so Joan wouldn't be allergic.

Well its all quite sad. Hopefully questions will be answered for her families sake, so they do not always wonder.

Continued prayers to Joan's family.

Re: I stand corrected! Joan Rivers procedure

prisrob — Tue, 09 Sep 2014 01:30:42 GMT

The sedation for endoscopies and many outpatient procedures is called 'conscious sedation'. Scopolamine has not been used in decades.

Re: I stand corrected! Joan Rivers procedure

pitdakota — Tue, 09 Sep 2014 02:43:53 GMT

On 9/8/2014 prisrob said: The sedation for endoscopies and many outpatient procedures is called 'conscious sedation'. Scopolamine has not been used in decades.

prisrob, some are using the term twilight sleep a little now instead of conscious sedation. Guess it is easier to say. lol But, I am like you....I see the term twilight sleep and I think of scopolamine. lol

Re: I stand corrected! Joan Rivers procedure

pitdakota — Tue, 09 Sep 2014 03:05:55 GMT

On 9/8/2014 scotttie said:
I thought that sedation for the procedure Joan had was the same as endoscopy or colonoscopy.

Evidently, upon further research, what she had requires General Anasthesia.

The doctors have been talking about Propophol so perhaps that's what they used but this is not the same as the twilight sleep I have been talking about on several threads here.

Pitdakota. Come.

Propofol can be used to induce and maintain anesthesia or sedation. It can be given as a one time dose for conscious sedation. It has a rapid onset of action and a very short half life which makes it a good choice for procedures such as endoscopy, etc. It can also be infused via IV drip to produce anesthesia for a longer period of time. That is usually called monitored anesthesia care (MAC).

Just one of the reasons I have said we need to wait for the results of the investigation to know for sure what happened. We technically don't know exactly which procedure Joan had. Furthermore, we don't know if it was conscious sedation or MAC. We really don't know the agent that was used. We don't know if she respiratory arrested during the procedure or right after the procedure. We don't know when they tried to intubate her, or even if they did.

One thing I do question is that if as she arrested she had an acute laryngospasm which interfered with intubation. I have seen that happen both in the ER and OR. It is not all that common, but when it happens the best doc can have a dickens of a time getting that endotracheal tube placed due to the obstruction. And when that happens, you can't get oxygen to the patient. Doesn't make any difference whether you are in a hospital or an outpatient setting. They can have extreme difficulty passing that endotracheal tube under those circumstances.

And yes, unfortunately I have seen severe brain damage due to the time that it took to intubate the patient under those circumstances. But it wasn't because the doc was not doing everything possible and trying like the dickens. Fortunately, it hasn't been that often. But I have seen it happen.

Bottom line is we just don't know the sequence of events and will have to wait.

Re: I stand corrected! Joan Rivers procedure

151949 — Tue, 09 Sep 2014 03:08:40 GMT

On 9/8/2014 prisrob said: The sedation for endoscopies and many outpatient procedures is called 'conscious sedation'. Scopolamine has not been used in decades.

Scopolamine is a drug given with anesthesia for the prevention of post anesthesia nausea. It is not a sedative or anesthesia drug.

Re: I stand corrected! Joan Rivers procedure

pitdakota — Tue, 09 Sep 2014 03:17:40 GMT

On 9/8/2014 happy housewife said:
On 9/8/2014 prisrob said: The sedation for endoscopies and many outpatient procedures is called 'conscious sedation'. Scopolamine has not been used in decades.

Scopolamine is a drug given with anesthesia for the prevention of post anesthesia nausea. It is not a sedative or anesthesia drug.

HH, the term "twilight sleep" refers back to the 1960s (before my time in nursing) when they used scopolamine for women in labor. It certain isn't used for that any more.

And it is certainly correct that in some cases they might give scopolamine as they are bringing the patient up from general anesthesia to deter post op nausea. However, there are many newer medications they commonly use for that today.

Prisrob saw twilight sleep and immediately thought scopolamine as many health care professionals would knowing of its use in the 1960s.

Re: I stand corrected! Joan Rivers procedure

scotttie — Tue, 09 Sep 2014 03:26:40 GMT

On 9/8/2014 pitdakota said:
On 9/8/2014 prisrob said: The sedation for endoscopies and many outpatient procedures is called 'conscious sedation'. Scopolamine has not been used in decades.

prisrob, some are using the term twilight sleep a little now instead of conscious sedation. Guess it is easier to say. lol But, I am like you....I see the term twilight sleep and I think of scopolamine. lol

Pitdakota, thank you for the information. My initial confusion was as to the endoscopy. All of the news (and her friends?) have been saying she was having her hoarse voice checked out. Of course that would not be an endoscopy since it was not due to her esophagus (?).

I think my mistake was in thinking "twilight sleep" and conscious sedation were the same thing. I have had numerous colonoscopies and an endoscopy and they used Versed and Demerol, I believe. For my DD's bone marrow aspirations and bone marrow biopsies they used Fentanyl and Versed.

Anyway, I plead guilty to the original mention of "Scopolamine" . See my post #3. I looked up "twilight sleep" in my daughter's current issue of Tabers and that is where I got that word. I had never heard of it before.

******

Re: I stand corrected! Joan Rivers procedure

151949 — Tue, 09 Sep 2014 03:35:09 GMT

On 9/8/2014 pitdakota said:
On 9/8/2014 happy housewife said:
On 9/8/2014 prisrob said: The sedation for endoscopies and many outpatient procedures is called 'conscious sedation'. Scopolamine has not been used in decades.

Scopolamine is a drug given with anesthesia for the prevention of post anesthesia nausea. It is not a sedative or anesthesia drug.

HH, the term "twilight sleep" refers back to the 1960s (before my time in nursing) when they used scopolamine for women in labor. It certain isn't used for that any more.

And it is certainly correct that in some cases they might give scopolamine as they are bringing the patient up from general anesthesia to deter post op nausea. However, there are many newer medications they commonly use for that today.

Prisrob saw twilight sleep and immediately thought scopolamine as many health care professionals would knowing of its use in the 1960s.

Really, when i had both of my knee surgeries in 2011 and 2012 i had scopolamine preop for my history of serious vomiting post anesthesia. I guess the anesthesiologist didn't get your memo. It has been given pre op for years as an antiemetic. Yes, in the 60's and 70's it was commonly used. In those days patients were given pre op meds before all surgeries that almost always included scop.- usually with demerol.

Re: I stand corrected! Joan Rivers procedure

pitdakota — Tue, 09 Sep 2014 03:38:43 GMT

On 9/8/2014 scotttie said:
On 9/8/2014 pitdakota said:
On 9/8/2014 prisrob said: The sedation for endoscopies and many outpatient procedures is called 'conscious sedation'. Scopolamine has not been used in decades.

prisrob, some are using the term twilight sleep a little now instead of conscious sedation. Guess it is easier to say. lol But, I am like you....I see the term twilight sleep and I think of scopolamine. lol

Pitdakota, thank you for the information. My initial confusion was as to the endoscopy. All of the news (and her friends?) have been saying she was having her hoarse voice checked out. Of course that would not be an endoscopy since it was not due to her esophagus (?).

I think my mistake was in thinking "twilight sleep" and conscious sedation were the same thing. I have had numerous colonoscopies and an endoscopy and they used Versed and Demerol, I believe. For my DD's bone marrow aspirations and bone marrow biopsies they used Fentanyl and Versed.

Anyway, I plead guilty to the original mention of "Scopolamine" . See my post #3. I looked up "twilight sleep" in my daughter's current issue of Tabers and that is where I got that word. I had never heard of it before.

******

Scottie, I heard a physician of one of the TV shows use the term twilight sleep when talking about Joan's case. So it isn't just you.

Today scop is not used for that as you noted. There are a few horrid stories of women that went bonkers when given scop. Not their fault by any means, but I remember hearing some really wild stories from Obstetric (the abbreviation for that is not allowed here ) nurses. Today's cocktails of meds for conscious sedation are much more reliable and in certain doses render the patient sedated but able to follow directions. Then of course for deeper sedation when necessary, they use the MAC approach.

Re: I stand corrected! Joan Rivers procedure

MickD — Tue, 09 Sep 2014 03:40:31 GMT

Very informative thread- thanks Scottie and gals.

Re: I stand corrected! Joan Rivers procedure

tansy — Tue, 09 Sep 2014 03:41:49 GMT

Twilight sleep just sounds creepy.

Re: I stand corrected! Joan Rivers procedure

scotttie — Tue, 09 Sep 2014 03:42:43 GMT

On 9/8/2014 pitdakota said:
On 9/8/2014 scotttie said:
On 9/8/2014 pitdakota said:
On 9/8/2014 prisrob said: The sedation for endoscopies and many outpatient procedures is called 'conscious sedation'. Scopolamine has not been used in decades.

prisrob, some are using the term twilight sleep a little now instead of conscious sedation. Guess it is easier to say. lol But, I am like you....I see the term twilight sleep and I think of scopolamine. lol

Pitdakota, thank you for the information. My initial confusion was as to the endoscopy. All of the news (and her friends?) have been saying she was having her hoarse voice checked out. Of course that would not be an endoscopy since it was not due to her esophagus (?).

I think my mistake was in thinking "twilight sleep" and conscious sedation were the same thing. I have had numerous colonoscopies and an endoscopy and they used Versed and Demerol, I believe. For my DD's bone marrow aspirations and bone marrow biopsies they used Fentanyl and Versed.

Anyway, I plead guilty to the original mention of "Scopolamine" . See my post #3. I looked up "twilight sleep" in my daughter's current issue of Tabers and that is where I got that word. I had never heard of it before.

******

Scottie, I heard a physician of one of the TV shows use the term twilight sleep when talking about Joan's case. So it isn't just you.

Today scop is not used for that as you noted. There are a few horrid stories of women that went bonkers when given scop. Not their fault by any means, but I remember hearing some really wild stories from Obstetric (the abbreviation for that is not allowed here ) nurses. Today's cocktails of meds for conscious sedation are much more reliable and in certain doses render the patient sedated but able to follow directions. Then of course for deeper sedation when necessary, they use the MAC approach.

Whoa! sounds like the Scop wasn't a good idea.

I have never been able to follow directions when under conscious sedation. But then, I say that, when in reality if I did I wouldn't be able to remember!

Anyway, I knew we could count on you to explain it all.

Re: I stand corrected! Joan Rivers procedure

scotttie — Tue, 09 Sep 2014 03:50:38 GMT

Hey! I just looked up Scopolamine in my dd's Nurse's Drug Guide and it says it is also known as Transderm Scop! haha! I used that as a patch when I went on a cruise years ago to help with motion sickness. It didn't help much