Colonoscopy & Conscious Sedation - page 2

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... Read More

  1. Visit  memorex profile page
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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.
  2. Visit  rn29306 profile page
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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.
  3. Visit  memorex profile page
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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?
  4. Visit  rn29306 profile page
    0
    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
  5. Visit  CrohnieToo profile page
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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
  6. Visit  fhtoloh71 profile page
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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?
  7. Visit  Spidey's mom profile page
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    I wonder what ever happened to GlennRoss . ... .the op was in 1999.




    steph
  8. Visit  maxm profile page
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    I have been a GI nurse for several years and I would definitely have sedation, even with our best physician doing this. I have seen some men tolerate this okay without sedation, but can't remember any women. Many of the nurses I work with have had this done and they all reccomend sedation.
  9. Visit  CrohnieToo profile page
    0
    Quote from fhtoloh71
    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?
    Another option if you want to see for yourself is to ask your gastro if he would give permission for just the monitor to be video taped during your colonoscopy. My gastro is perfectly comfortable with this, I doublel checked w/the Endo Dept head to be sure the hospital would be okay w/this and we've done it for about 6 scopes now. Until my last scope. Our charge nurse transferred to another department and the new charge nurse gave us some static last time and said it was THE LAST TIME we could video the monitor. So - my gastro and I do my scopes at another Endo center now. I have transferred the videos to CD and have a string of them on CD. You have to take your own video cam and tape and it does take one more person in the room to tape the monitor so that could be a consideration.

    Some really progressive Endo centers had the equipment to provide you w/a video of the procedure if you provided your own blank tape which is where I got the idea. But now that digital imaging has come into play .... our new digital imaging center in town has its entire second floor devoted to a newly formed gastro consortium's setting up an Endo center there. From what I understand they scopes are done w/some digital imaging but they don't have the equipment to make a CD for me and the file would be too large to e-mail it to me. Drats. So much for switching to that facility. *sigh*

    I'm sure all these colon innards are old hat to my gastro but given my Crohn's disease I find it fascinating to see what my own innards look like when we do a scope.
  10. Visit  george57 profile page
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    I have helped with many colonscopies and have helped patients without sedation. That's a choice you should make. However, the distention, from air and going around bends and curves, can be unconfortable. I choose to have sedation when I have my next one. As already suggested, bring a driver in case you change your mind.
  11. Visit  ciaobelly profile page
    1
    I had a colonoscopy without sedation yesterday, and, apart from one brief moment of pain, which was still quite tolerable, I would characterize the procedure as mildly uncomfortable. It was much preferable to having to deal with recovering from sedation.

    I had had an IV inserted before the procedure and told the doctor that I didn't think I would be nervous, but if there was a problem, she could give me a dose of painkiller, and if absolutely necessary, sedation. I don't think it was any more challenging for the doctor and nurse, as they chatted with each other as if I wasn't 'there,' checking in with me from time to time when they remembered I was awake. Meanwhile, I was fascinated to watch the procedure on the monitor.

    I have also had two upper endoscopies without sedation. They were tolerable, but much more unpleasant than the colonoscopy, as I had to manage the gag reflex and my breathing. Again, not fun, but still preferable to sedation.

    Please keep in mind that different patients have different needs around sedation. I am so thankful that mine were respected.

    (And in response to Maxm: I am a woman.)
    Last edit by ciaobelly on Sep 25, '08 : Reason: Included response to another post.
    neveragain likes this.
  12. Visit  CrohnieToo profile page
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    Amen, ciaobelly!!! I, too, am a woman. And I agree w/you completely about respecting the patients' choice regarding sedation!

    I found the upper endoscopy worse than the colonoscopy, both w/o sedation, due to my having a very strong gag reflex. And watching the monitor IS fascinating! Especially during colonoscopy when you can ask questions about what you see!! My gastro went thru both scopes w/o sedation before she would agree to do mine w/o sedation and she totally agrees w/me: the endoscopy is more uncomfortable than the colonoscopy due to the gag reflex!!!
  13. Visit  moho1521 profile page
    1
    I've worked in the GI lab for the last 6 years and I've had 5 patients who have opted for no sedation. They had physicians who were very patient and made sure that they talked the patient through what was going on during the procedure. It really is up to the patient, their anatomy and physician.
    neveragain likes this.

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