Valium, Demerol and Xanax: Too Much Medication for Blepharoplasty Surgery?

Question

In consideration of Blepharoplasty surgery, my doctor suggests using a cocktail of Valium, Demerol and Xanax for the in office procedure, along with local anesthetic. Does this sound like too much of the same type of medication?

David C. Pearson, MD · Answer

The combo of Valium and Xanax seems a bit weird and heavy-handed since they're both benzodiazepines. I've gotten away from prescribing Valium for in-office procedures mainly because of its long elimination half-life (20-80 hours, given its multiple metabolites). Valium has become kinda of "old school," if you will.
Ativan is a reasonable choice and I like it for longer procedures (e.g., 2-ish hours), since it's got a shorter half-life than Valium and is well tolerated.
Lately, I've been keen on Halcion (triazolam), especially for short procedures such as a bleph. It's got *no* active metabolites, works quickly, and is gone quickly (half-life of about 2-5 hours).
The Demerol is probably way over the top for this procedure given the typically trivial pain involved.
Best of luck,
--DCP

Sam Jejurikar, MD · Answer

Hi Helen,
This sounds like a lot of medication.  Valium and Xanax are both benzodiazepines and will potentiate each other's affects - you're better off choosing just one of those medications.  With this cocktail of medications, it's important that your physician's office monitor your vital signs during the procedure to ensure that you're not oversedated.
Hope this helps.  Best of luck.

Kenneth D. Steinsapir, MD · Answer

Dear Helen
Valium and Xanax have similar effects.  Demerol, although still commonly used, can cause hypotension and respiratory arrest especially in combination with other drugs.  If the doses are relatively small, the combination may be safe.  However, this type of cocktail is often used in office based surgery because it avoids a general anesthesia or deep iv sedation which in many states necessitates an accredited surgery center or hospital based operating room.  Upper eyelid and lower eyelid surgery is generally comfortable enough that a valium and local anesthestic is generally all that is needed.
To be quite honest, I do many of my eyelid surgeries in an accredited operating room so my patients can have IV sedation.  This is a good choice so that patients can be less aware of what is going on during surgery.  The drugs used are very short acting so that there is almost no hang over.  Comfort level is very good after these types of surgeries.

Michael A. Persky, MD · Answer

Hi Helen,
The Valium and Xanax are similar drugs.  I would suggest one or the other.
We usually give our patient Xanax 1 mg and either oral Vicodan or an injection of Demerol if they prefer.  Enjoy your more youthful eye lids.
Good luck and be well.
Dr. P

Chris Thiagarajah, MD · Answer

I usually give patients a 10mg Valium and they do fine. It sounds a little much for my tastes but if your surgeon is comfortable with this dosage and has worked for him or her, it should be ok. You can ask for less of course!

William Portuese, MD · Answer

It is not a good idea to have blepharoplasty performed in a doctor&rsquo;s office.  It is a sterile procedure that if not performed properly can result in disastrous consequences such as infection.
Blepharoplasty surgery is usually performed under general anesthesia because of the pain associated with removing the fat pads from both the upper and lower lids, which do not numb up sufficiently with local Novocain-type medications.  Valium, Demerol, and Xanax are all respiratory agents and should be administered and monitored in a surgery center setting, not in a doctor&rsquo;s office.  It is also best to have a board-certified physician anesthesiologist perform the anesthesia in a certified ambulatory surgery center, not a doctor&rsquo;s office.

Darryl J. Blinski, MD · Answer

Sounds good to me. But if you are so concerned than discuss this issue with your surgeon in detail. Or until you are satisfied with his explanation. Regards.

Jason B. Diamond, MD, FACS · Answer

For upper Blepharoplasty I usually use 10mg Valium, 1 coding and the local anesthesia infiltration. This combination is more than enough to make this a painless procedure. It sounds like a lot of medication you will be getting for this procedure.

Charles Perry, MD · Answer

For a Blepharoplasty surgery an anxiolytic such as Valium or Xanax, and an analgesic such as Demerol are usually utilized to assist with the local injection of anesthetic and can make the procedure a little more comfortable. They are for your comfort and if you would rather not have them I am sure your physician would be open to your concerns and perhaps do the surgery under straight local. Best wishes.

Kamran Khoobehi, MD · Answer

If you are going to have upper eyelid ,this combination may be too much. Please discuss your concerns with your doctor and make sure that they have back up incase of the too much sedation.

Valium, Demerol and Xanax: Too Much Medication for Blepharoplasty Surgery?

Answers (11)

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