[n577450]

Thanks suanna-I'm learning a lot...most GI labs (almost all) have 2 options: chemical lobotomy with versed/fentanyl or versed/demerol (if they are in the stone age-demerol is really old-hat. give it to about 10% of patients and they seize from the accumulation of normeperidine-a toxic metabolite)...but since they use it in tiny doses it's not usually a problem. fentanyl is safer. propofol is used in most states by anesthesia only...............I'll probably be in bad shape by the time I get this sorted out; one bright spot: I called the Cleveland Clinic today and they let me talk to a GI doc who said: no sedation, no problem if you don't mind the pain...a majority of the docs have it that way..and as far as an IV, if they aren't giving drugs, they do NOT start an IV, it's not needed and indeed it's an accident waiting to happen...now, if I just lived anywhere near the Cleveland Clinic........I would be comfortable if any of the nurses who responded to this message were doing my test and I would relax completely. I never met any of you, but the trusting attitute shows. The nurses and docs here in PA-I would not trust them to wash my car......

[hypocaffeinemia]

Edit: my reply isn't valid after reading through the thread.

Regarding the propofol allergy, there is a version about to be released on the market late summer/early fall that is water soluble and may not contain egg products. It's brand name is aquavan and you and your providers may want to look into it as an acceptable sedation agent.

[n577450]

Believe it or not, the allergic reaction that I had was overseas to the pro-drug of propofol that you are referring to called fospropofol (Aquivan)......it's not released in the usa yet, but I'm allergic to the drug even without the egg-base..thanks

[n577450]

Also, I need to get this done without any sedation; propofol is fine for some....overkill, emphasis on the kill part for me.....but a wonderful suggestion for most......

[CRNA2007]

IMO, an IV is essential. Even with an egg allergy most people do fine with propofol. The sedation not only helps you to relax it also helps to relax the bowels so the physician can get the scope where it needs to be.

[n577450]

Thanks again for all the replies; it's hard to describe how violated that I felt when I specified "no sedation" then they did it anyway and I ended up getting really, really hurt and still didn't get the exam. The GI nurse in charge of the endo suite said to stop arguing with the "gatekeepers", schedule the exam, show up and write on the consent "no drugs or IV fluids" and remind the MD why......The GI nurse says that they will argue, but be firm..once you are there, they will do the exam without drugs or an IV rather than lose the "slot" and lose money. And she said that many of the docs that they scope do it that way. She's been a Gi nurse for a long time and says versed is usually o.k., but sometimes doesn't work and sometimes really is a problem. Having CRNA and propofol is completely safe, but if you don'y want sedation, what pay them to be there? And without sedation, you don't need an IV and all of the unecessary monitoring, EKG, pulseox and you can drive right home. She used to work at the Cleveland clinic and they do a lot without drugs no oxygen, ekg's. etc and it's much cheaper and safer

[hypocaffeinemia]

There are multiple reasons for IV access, and EKG/SpO2 monitoring even without sedation.

You may suffer from orthopnea- shortness of breath from lying in awkward position. Routing through your colon and puffing it full of air may stimulate a vagal response, sending you bradycardic. There are risks of perforating the colon, in which IV access would be necessary to control fluid administration, pain relief, and even anesthesia if surgical repair is required. Associated with the increase in vagal tone, some patients hold their breath due to the pressure in their colons which reduces SpO2 and can result in syncopal episodes.

And that's just the list off the top of my head. I'm sure your GI doc could elaborate more.

IV, EKG, NIBP, and SpO2 are hardly unnecessary monitoring when undergoing an invasive procedure, regardless of anesthesia use.

[mshultz]

Originally Posted by n577450

Thanks for the replies; all of you have encouraged me to get the test....found a doc who said "no sedation", so once again I did the prep. reported for the exam, changed into the designer outfit and lo and behold: a nurse "requires" me to sign a "sedation consent" since it's "policy". After talking to the doc in an office visit for 30 minutes, I thought that we finally had this straight. And needless to say, I didn't want the IV (would ANY) of you trust these people under these circumstances? I mean: sign a blank consent after the doc specifically agrees not to do the sedation.....oh, sedation and narcs are not going to be used, there is NO medical indication to start an IV; if something happens, there are enough nurses around to start one in seconds.......and if your BP drops, vaso-vagal response, a pissant peripheral IV won't matter, expecially in the endocscopy suite. Once again, the GI lab people argued over what to do and I just got dressed and left........And now my CEA (sp) bloodwork indicated some sort of problem; but I give up. I tried.

This is why doctors should be required to get their OWN consents. I am convinced that effective communication is impossible, otherwise. I have signed 3 consents (EGD, blood transfusion, colonoscopy) without even meeting with the doctors prior to the procedures. The consents were blank; there was no discussion of risks, benefits, and alternatives. I signed them because I was naive and trusting.

There are hospitals that require the doctors to sign their own consents (at least 2 in my area), and advertise that on their websites. In the future, I will request a meeting with all of the people involved with the procedure, so that we can go over the consent together. This way, I know we all have the same information, and I am in the loop.

[mshultz]

Originally Posted by n577450

Thanks again for all the replies; it's hard to describe how violated that I felt when I specified "no sedation" then they did it anyway and I ended up getting really, really hurt and still didn't get the exam. The GI nurse in charge of the endo suite said to stop arguing with the "gatekeepers", schedule the exam, show up and write on the consent "no drugs or IV fluids" and remind the MD why......The GI nurse says that they will argue, but be firm..once you are there, they will do the exam without drugs or an IV rather than lose the "slot" and lose money. And she said that many of the docs that they scope do it that way. She's been a Gi nurse for a long time and says versed is usually o.k., but sometimes doesn't work and sometimes really is a problem. Having CRNA and propofol is completely safe, but if you don'y want sedation, what pay them to be there? And without sedation, you don't need an IV and all of the unecessary monitoring, EKG, pulseox and you can drive right home. She used to work at the Cleveland clinic and they do a lot without drugs no oxygen, ekg's. etc and it's much cheaper and safer

There used to be a website about colonoscopy without sedation. This was the same advice (argue with them) that doctor gave. However, after thinking about this issue for a few years, I am convinced that it is bad advice. You are much better off going to someone who routinely performs colonoscopies without sedation, and is comfortable with this. Why try to coerce someone into doing something they do not want to do, when there are alternatives? Ask for a referral to someone who is able to meet your needs.

[mshultz]

Originally Posted by n577450

Thanks suanna-I'm learning a lot...most GI labs (almost all) have 2 options: chemical lobotomy with versed/fentanyl or versed/demerol (if they are in the stone age-demerol is really old-hat. give it to about 10% of patients and they seize from the accumulation of normeperidine-a toxic metabolite)...but since they use it in tiny doses it's not usually a problem. fentanyl is safer. propofol is used in most states by anesthesia only...............I'll probably be in bad shape by the time I get this sorted out; one bright spot: I called the Cleveland Clinic today and they let me talk to a GI doc who said: no sedation, no problem if you don't mind the pain...a majority of the docs have it that way..and as far as an IV, if they aren't giving drugs, they do NOT start an IV, it's not needed and indeed it's an accident waiting to happen...now, if I just lived anywhere near the Cleveland Clinic........I would be comfortable if any of the nurses who responded to this message were doing my test and I would relax completely. I never met any of you, but the trusting attitute shows. The nurses and docs here in PA-I would not trust them to wash my car......

The Cleveland Clinic is in my neighborhood. I suspected that when I am due for another colonoscopy (in about 5 years), I would not have to leave Ohio to find a doctor proficient in doing them without sedation. You have confirmed that. Thank you. Going to Cleveland is better than going to California or UK, which are 2 other locations I have read about on this forum. Plus, you are the first person to mention a medical center by name, so that I would actually know who to call.