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Thursday, December 19, 2013
Colonoscopy Sedation Diprivan, MAOI, Lisinipr
I was told that for my scheduled colonoscopy I would be given Diprivan (propofol). I am on 45 mg Nardil (MAOI) and 10 mg of Lisinopril daily. In addition, I use a CPAP machine (100% compliant)for sleep apnea.
Should I be concerned about any adverse reactions with the sedation Drug? Since the Lisinopril works with the Nardil in tandem to lower my blood pressure, if I am given too much Diprivan, should I be concerned with respiratory malfunction due to my sleep apnea? Is there another drug that would be better? What should I request to be in the procedure room and should I ask for an MD anesthesiologist?
Thanks for your question.
You are raising at least two, bright red flags.
1. Sleep apnea is a serious issue in any patient undergoing anesthesia. Airway obstruction is more likely to occur during and after anesthesia. Difficult tracheal (windpipe) intubation is also more common.
2. Nardil is an MAOI - a monoamine oxidase inhibitor. MAOIs can interact with certain anesthesia-related medicines, including meperidine (Demerol) and ephedrine, to cause severe reactions. In fact, until a few years ago it was standard practice to discontinue MAOIs before anesthesia. Although this is no longer routinely advocated, caution is still advised.
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In view of these two important and well-recognized anesthesia risk factors, it would be wise to request an MD anesthesiologist to provide your sedation for colonoscopy and to supervise your recovery. The anesthesiologist should advise you how to manage your medications before the procedure so ideally you will make contact beforehand.
Finally, please note that in some centers, the use of lisinopril on the day of anesthesia is discouraged because in combination with general anesthesia (e.g. propofol) it can cause low blood pressure. This is one more reason to contact your anesthesiologist before the colonoscopy.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University