Sedation for Radiological Imaging
It is not uncommon for patients to requests prescriptions for sedative medications (such as diazepam or ‘Valium’) when they are undergoing radiological procedures such as MRIs.
Unfortunately, this is not something we are able to do for the following reasons:
Sedation Management
Patients who are sedated should be regularly monitored. We are aware of a case report where a GP-provided sedation was given, the patient was not monitored, and subsequently had a respiratory arrest in an MRI machine.
Benzodiazepines
Benzodiazepines such as 2mg diazepam are probably sub-therapeutic for most adults for any effective sedation. Equally they can sometimes have an idiosyncratic response in patients, and even very small doses can sometimes cause agitation.
Timing of Sedation
A patient may take a sedative ‘an hour’ before their assumed procedure, only to find their procedure has been delayed, leading to unpredictable dosing requirements.
GP Involvement
GPs are not regularly involved, skilled, trained or appraised in sedation skills. Hospital consultants, both those requesting imaging and those providing it, have access to the same prescribing abilities as GPs.
Guidelines
The Royal College of Radiologists‘ own guidelines on sedation for imaging makes no mention of GP involvement or provision of low dose sedatives. It also stresses the importance of experienced well-trained staff being involved with and monitoring sedated patients. Sedation, analgesia and anaesthesia in the radiology department,
Where the referral for imaging is made by our practice, we will try to highlight on the referral that an assessment for support by the radiology team may be beneficial.
Fear Of Flying
Patient Prescribing Policy
Tollgate Medical Centre have taken the decision to no longer prescribe sedatives for fear of flying. This policy decision has been made by the GP Partners and is adhered to by all prescribers working in the practice.
The reasons for this can be found below:
- Benzodiazepines (like diazepam) are sedatives, which means they make you sleepy and more relaxed. If there is an in flight emergency they impair your ability to concentrate, follow instructions and react to the situation. This could have serious safety consequences for you and your fellow passengers and crew.
- Sedative drugs can make you fall asleep, however when you do sleep it is an unnatural non-REM sleep. This means you won’t move around as much as during natural sleep. You can then be at increased risk of developing a blood clot (DVT) in the leg or even the lung. Blood clots are very dangerous and can even prove fatal. This risk is even greater if your flight is greater than four hours.
- While most medications like these are sedative, sometimes they can cause agitation and in aggression. They can also cause disinhibition and lead you to behave in a way that you would not normally. This could impact on your safety as well as that of other passengers and could also get you into trouble with the police.
- According to the prescribing guidelines doctors follow Benzodiazepines are not licensed for use in phobia. Your doctor is taking a significant legal risk by prescribing against these guidelines. If this is the case, you should be getting proper care and support for your mental health and not for going on a flight.
- Diazepam and similar drugs are illegal in many countries. They may be confiscated or you may find yourself in trouble with the police.
- Diazepam stays in your system for quite a while. If your job requires you to submit to random drug testing you may fail this having taken diazepam.
We appreciate that fear of flying is very real and very frightening. A much better approach is to tackle this properly with a Fear of Flying course run by the airlines and we have listed a number of these below.
Easy Jet www.fearlessflyer.easyjet.com Tel 0203 8131644
British Airways www.flyingwithconfidence.com Tel 01252 793250
Virgin www.flyingwithoutfear.co.uk Tel 01423 714900
You may find other options by typing “Fear of Flying courses” into your usual internet search engine