Help. I am an RN, 51 y/o, family hx of colon cancer. I am scheduled for colonoscopy and GI Doc is insisting on sedation. I have paradoxical reactions to most drugs used in sedation. Based on my reading the only reason for sedation could be scope insertion and placement. Please share experiences you know of where patients had procedure without sedation and did well; or give me specific details on why sedation is required - extent of pain, duration, etc. I am extremely supportive of Nursing, but all of this sedation for every out patient procedure seems to be a revenue driver, not a best care practice. I need help in making this decision, but my thoughts are to refuse and if necessary cancel the procedure. Glenn
May 25, '09
I'm a CRNA and do a lot of sedations for endoscopy. I've only seen one patient who had a colonoscopy with nothing - she was 75 years old and had a fear of anesthesia. Yes, it is possible to have a colonoscopy without sedation but it sure isn't comfortable. As long as you can lie still in case a polyp has to be removed, you'll be fine. Patients who are highly motivated not to receive sedation usually do well. I've often thought of this "revenue driver" idea that you mention and yes, endoscopy is revenue for my group BUT, when a an endoscopist is doing 10 to 18 cases a day (the usual for us), we don't have time to accommodate squirming, miserable patients. I had a patient who had a colonoscopy without any anesthesia in Canada and it took her 14 years to come for another one and she had a history of colitis! We use only propofol and a whiff of fentanyl and I've never seen a parodoxical reaction (more often happens with versed). The procedure takes about 15 minutes if its just a look-see and you can add two or three minutes for each polyp that hadsto be removed. Some patients have insurances that won't cover anesthesia services in an out-patient setting and they get versed and fentanyl and do fine. If your endoscopist won't do the procedure without sedation, find one who will. Whatever you decide, get it done. It's very rewarding when we get a "save" and it happens daily.
May 26, '09
I had a full endoscopy done (mouth to to the rectum) at the Brigham in Boston a few years ago, and was allowed to remain awake throughout. I agreed to accept sedation if my reactions interfered with the MD's efforts, but it worked out fine. The worst part was when they were examining my stomach - as they manipulated the scope I felt waves of nausea and began reflexively to heave. Once the the scope was advanced beyond the stomach it was no big deal at all, they even snipped off a polyp thingy at one point and I barely felt anything. I found it fascinating watching the video of the transit through my gut.
May 28, '09
Everyone's tolerance is different. I, too, have done a lot of colonoscopies for people with propofol (I don't give narcotics or versed) since out program is called, "Fast Track" and propofol goes out of your body so quickly, the post op is a breeze. I've had all that I can remember (could be 100%) very happy and relieved that it was so easy.
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