Colonoscopy & Conscious Sedation

rn29306 · Apr 24, 2006

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.

memorex · Apr 25, 2006

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.

rn29306 · Apr 25, 2006

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.

memorex · Apr 26, 2006

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?

rn29306 · Apr 26, 2006

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.

CrohnieToo · May 5, 2006

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/html/board/index.php/action=displaythread&forum=boweldisorders&id=12&realm=default

Why Colonoscopy Is More Difficult In Women

http://www.e-health-questions.info/html/board/index.php/action=displaythread&forum=boweldisorders&id=13&realm=default

Also, one should feel nothing during a biopsy or polyp removal. I never have.

fhtoloh71 · Nov 10, 2007

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?

allnurses Guide · Nov 10, 2007

I wonder what ever happened to GlennRoss . ... .the op was in 1999.

steph

maxm · Nov 28, 2007

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.

CrohnieToo · Nov 28, 2007

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.

george57 · Jan 5, 2008

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.

ciaobelly · Sep 25, 2008

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.)