Colonoscopy & Conscious Sedation - page 2

by GlennRoss 102,745 Views | 53 Comments

Help. I am an RN, 51 y/o and family hx of colon cancer. I'm scheduled for next week. GI Doc is insisting on sedation for the procedure. After extensive reading I can find no valid reason for sedation other than when the scope... Read More


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    I have had ulcerative colitis since age 11, back in the dark ages, children were not sedated for that procedue..nor was I ever medicated for pain during my 6 week hospitalization, for that matter. The pain was incredible, as I had active UC at the time; I cried until a nurse yelled at me, then I shut up, because, as she so nicely put it, "does crying help?" .
    Now I am 49, and I am supposed to have a yearly colonoscopy because of the increased risk of colon cancer due to the ulcerative colitis. I did not start having sedation for the procedure until it was offered to me, (I was about 30) Iniatially, the sedation must have been fairly light, because I remember waking up during the procedure and moaning in pain; the doctor's response was always, "it's almost over."
    Over the past 10 years or so, I always get sedation-the last time it was a drip of ditropan(?) worked great/I had no memory at all of the procedure/minimal sleepiness after the procedure and no nausea!
    Having had a colonoscopy with and without sedation, guess which one I would pick? (sedation, without a moment's hesitation!)
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    I had a couple of colonoscopies back in the early 1990s when I was having some sort of inflamatory bowel problem. Even with sedation they were EXCRUCIATING! They hurt so bad they could not be completed. The second time I screamed so much, they increased whatever sedation/pain med to the point that I stopped breathing. I know that happened because the pain went away, then started to come back as someone was telling me to breathe.

    As a result, I have not had another one although I should probably do so.

    I should have asked what medications they were giving me in the IV because I have been told now that my records were destroyed after 7 years. After doing some reading, I suspect I had a "paradoxical reaction" to the seditive.

    Anyone remember what were the seditive and pain drugs of choice used back from about 1991 to 1995? If I have to have another procedure, I don't want the same seditive!
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    Quote from memorex
    I had a couple of colonoscopies back in the early 1990s when I was having some sort of inflamatory bowel problem. Even with sedation they were EXCRUCIATING! They hurt so bad they could not be completed. The second time I screamed so much, they increased whatever sedation/pain med to the point that I stopped breathing. I know that happened because the pain went away, then started to come back as someone was telling me to breathe.

    As a result, I have not had another one although I should probably do so.

    I should have asked what medications they were giving me in the IV because I have been told now that my records were destroyed after 7 years. After doing some reading, I suspect I had a "paradoxical reaction" to the seditive.

    Anyone remember what were the seditive and pain drugs of choice used back from about 1991 to 1995? If I have to have another procedure, I don't want the same seditive!
    You were most likely given a powerful narcotic named Fentanyl due to your coming out of whatever baseline sedation you had on-board at the time. Fentanyl adjusts your CO2 curve and people can and will stop breathing with narcotics of this nature.

    Technology and pharmacology have come a long way since your experience. Ask for anesthesia to administer propofol for your next scope and it will be a night and day expereince to what you posted above. Good luck and let us know how it goes.
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    Thanks rn29306! I've made a note of that.

    Outside of pain issues, I also worry about respiratory failure during that procedure. I certainly don't want to go out that way!

    In the last couple years I've developed high blood pressure, controlled by tiazac (diltiazem), a calcium channe blocker. Seems that does not go well with fentanyl, so they should not use that on me nowdays anyway.

    As I've gotten older I seem to be developing sensitivities to drugs. I've had to give up caffeine and I had a bad reaction to beta blockers. I worry about potential bad reactions to tranquilizing agents.

    You can bet that if I have to have a colonoscopy again, I will insist on talking with the physician before hand and I will have a whole lot of questions. If I can't get satisfactory answers I will insist on someone else.
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    Quote from memorex

    In the last couple years I've developed high blood pressure, controlled by tiazac (diltiazem), a calcium channe blocker. Seems that does not go well with fentanyl, so they should not use that on me nowdays anyway.
    Of all the narcotics we give, fentanyl is the most cardiac stable. No histamine release, minimal change in HR, perhaps a modest decrease in BP.
    There is a reason that "cardiac anesthesia", the old school way of doing anesthesia for open heart patients, is based almost entirely around massive amounts of fentanyl. Even today, some of our old-school anesthesiologists give 40-60 mls of fentanyl on induction of CAB anesthesia. Keep in mind that 1 ml is 50 mcg.

    Very rarely will you see hypotension with the doages used in conscious sedation. Any depressive effects (which will be minimal) will be offset by the stimulus of the procedure.

    Again, let us know how it goes. I would encourage you to utilize anesthesia for your next visit, but that is an individual choice.
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    I would most certainly use anesthesia, my only question is which one would work on me, since what I had in the early 1990s did not work. "Conscious sedation" was conscious alright but not sedating. I remember the whole painful event.

    Does propofol put you out completely?
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    Quote from memorex
    I would most certainly use anesthesia, my only question is which one would work on me, since what I had in the early 1990s did not work. "Conscious sedation" was conscious alright but not sedating. I remember the whole painful event.

    Does propofol put you out completely?
    Traditional CS uses versed and fentanyl, which sounds like what you had previously. While versed does cause amnesia in most cases, it is not 100% foolproof. Fentanyl is given for the pain, but it may or may not cause amnesia. Propofol given by an anesthesic professional virtually gurantees a comfortable amnestic procedure. Propofol has no analgesic effects, so you may also be given small amounts of narcotics as well.

    The beauty of propofol for such procedures as this is that it allows you to have virtually a totally amnestic procedure with a rapid return to your normal functioning status. Most people leave and return to their daily lives immediately after leaving the office or hospital. We did a MD one day that was playing golf two hours later after leaving our outpatient surgery area.

    Explore your options. It is certainly a buyer's market.
    Last edit by rn29306 on May 6, '06
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    I would recommend the following two articles to anyone considering a colonoscopy w/o sedation. After an incomplete colonoscopy due to reaction to Versed and a successful (and comfortable) colonoscopy w/diprivan (propofol) I have had my subsequent colonoscopies w/o sedation, just demerol and occasionally some phenergan if the vagus nerve gets in a twit and causes gagging when "we" get to the transverse colon/hepatic flexure at my insistence. The big thing is the skill and consideration of my gastro. My scopes do take longer because she must take her time. Yes, I do encounter some discomfort at that transverse colon (mine is redundant)/hepatic flexure and at the ileocecal valve penetration but not so much as to make me want sedation. I WANNA WATCH AND SEE FOR MYSELF. Do read the two following articles:

    A Study of Pain During Colonoscopy

    http://www.e-health-questions.info/h...&realm=default

    Why Colonoscopy Is More Difficult In Women

    http://www.e-health-questions.info/h...&realm=default

    Also, one should feel nothing during a biopsy or polyp removal. I never have.
    Last edit by CrohnieToo on May 5, '06
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    Due to family and personal history, I have colonoscopy about every 2-3 years. My doctor is great, and I never have any memory of the procedure. The last one was done with an anesthesiologist giving me propofol and demerol. I don't want pain, but I'm a bit of a control freak and I am very curious, so I think I would like to try watching the video screen if I can. I am considering asking the anesthesiologist to give me a very minimal dose unless I find I can't tolerate the pain, in which case to give me whatever it dose takes. Does any one have any advice about this?
  10. 0
    I wonder what ever happened to GlennRoss . ... .the op was in 1999.




    steph


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