MAB32 I am sorry to read about your experiences, hopefully my experiences will be helpful.
Your experience with "conscious sedation" was clearly inadequate. As I've been trained, the goals of conscious sedation are sedation, analgesia, and amnesia such that a patient can undergo an otherwise painful (physical or mental) procedure without interim or post procedure anguish. The limitation is trying to avoid airway management issues by keeping the patient "conscious."
Versed is an extremely popular and prevalent choice for conscious sedation given its quick onset and relatively quick offset as a benzodiazepine. We use it all the time in the ICU, bronchoscopy and endoscopy suites, and the ER. In fact, in large doses, it can be used to render patients unconscious for intubation. In no way is it an irresponsible choice for your procedure, although ITS EFFECTS ARE DIFFERENT ON DIFFERENT PEOPLE. That is, if you were fully awake after receiving ridiculous amounts, your docs should have picked something different.
As for suing your docs for using versed, that's plain ridiculous. In fact, your cleveland cardiologists advice of using demerol and valium seems VERY strange to me- valium first of all is in the same class of medications (benzodiazepines) which is to say that if versed doesn't float your boat, valium won't do it either. Valium also has a MUCH LONGER half life- that is to say that you will now create a much longer recovery time which can translate into needing to be admitted for recovery, greater risk for aspiration syndromes, among other things. I don't know ANY conscious sedation protocol that recommends the use of valium- the pharmacologic properties of the drug are simply all wrong for this type of scenario! He IS right in that they should have added a narcotic like fentanyl or demerol to the cocktail (assuming your BP wasn't too low).
As an aside, I will add that heavy drinkers commonly are tolerant to benzos- that is to say that they can take a lot more of the drug with less effects. That's not a personal jab, by the way.
In my opinion, though, in an ICU setting or a setting where the patient is well monitored, the best drug to use on ANYBODY for a very quick procedure is propofol. It is ideal due to its EXTREMELY rapid onset and offset - we are talking minutes instead of hours like versed (or MANY hours like valium). Thus a bolus can be given and the patient monitored for breathing and vital signs- if awake, you can push more, if not, do the procedure and know that the drug will be gone in a few minutes and the pt will wake up. If you give too much, the patient again will be ok in a few minutes provided you don't let them get hypoxic on you in the interim.
The other drug that I like, and is my choice for induction for intubation is etomidate- works with the least cardiac side effects (hypotension), although is not as convenient as propofol given a longer half life.
So, the bottom line as far as I am concerned for drugs that you personally would need for cardioversion would be either propofol or etomidate + a quick acting narcotic like fentanyl. I would reiterate that versed would also be a number one choice for me for longer procedures- but you have shown that you personally are tolerant to it- and that counts for something as well. But I wouldn't blacklist it given the hundreds of people I have used it on with fantastic results. Just not on you!!
Hope this helps, I know it's long, but I'm having a REALLY slow day!!
-G
ps. If you come in unstable- chest pain/hypotension/decreased consciousness almost nobody is going to "waste" time on sedation- you're gonna get cardioverted STAT.
pps. Narcan won't reverse benzos, flumazenil will (that's prob what was really in the syringe)
ppps. The really nice thing about the benzos is a phenomenon known as retrograde amnesia- that is, if someone is cardioverted, and they go "Owie!!" you can push benzos in an attempt to delete that memory, even though it occured prior to receiving more drugs. It works very well (although again, not in you I guess).