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Anesthesia

Safety of Demerol and Versed on Stage 3 Kidne

03/10/2008

Question:

I currently have Stage 3 Chronic Kidney Disease. I am currently not on any medication for this.

I am scheduled for an upper Endoscopy next month and they use Demerol and Versed for sedation. Are these medications safe for me?

Please advise. Thank you very much

Answer:

Demerol is not the best choice for a patient with kidney disease. This opioid drug, also known as meperidine, accumulates and can cause toxicity in patients with limited renal function.

You are not likely to be given a large amount of meperidine during an endoscopy, and you do not have end-stage renal disease, so the chances that you come to any harm from the meperidine is probably quite small. Nevertheless, other opioids, like fentanyl, do not cause these problems in patients with kidney disease and would be a better choice.

Midazolam should not be a particular problem for you, except that the doses used should be carefully adjusted to effect. The same is true for the whatever opioid or other sedative is used. Propofol is a good choice. It's commonly used by anesthesiologists for sedation for endoscopic procedures.

Patients with kidney disease need to be specially cautious with a wide range of medications, because so many of the medications we use are broken down and excreted by the kidneys. Kidney patients are therefore much more likely to experience problems with overdose. Overdose with sedative and analgesic medications is just such a problem, and can lead to very serious adverse effects relating to the suppression of breathing.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University