Colonoscopy & Conscious Sedation - page 4

by GlennRoss 102,760 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 just had a colonoscopy and gastroscopy without sedation, it was uncomfortable but still prefer it as I can remember it, so I feel I gained more information then with sedation. I had the colonoscopy with sedation some 8 years ago and spent a lot of time trying to rember what the doctor told me. then had it repeated with no sedation a week or so later.
    neveragain and darne20 like this.
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    Versed (midazolam) is given for amnesia effect only; colonoscopy can be and is often done, quite comfortably with nothing or painkiller (fentanyl) only........most docs "insist" on amnesia/sedation drugs because they can do the procedure more quickly......
    neveragain likes this.
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    Quote from darne20
    Versed (midazolam) is given for amnesia effect only.....
    Versed is also given to make the patient relaxed, drowsy, or sleepy, depending on the dose given. A patient who is anxious or nervous will have more muscle tension in the abdomen, making the procedure more difficult and more painful.
    darne20 likes this.
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    Good point Bootynurse; if a patient is anxious and wants to be made amnesic and sleepy, fine, they should be offered Versed as an option. I did not phrase my comment very well; but it has been my experience that a LOT of patients are told that Versed is "required" and that a significant percentage find the amnesia really creepy and haunting. I had one done with Versed and found the experience awful, just because of the "creepy amnesia" from Versed and not being able to communicate with the GI doc. And I have met many patients who report that Versed was, by far, the worst part of the procedure. My wife, (an advance-pactice RN) has had several procedures and loves Versed......go figure....I just believe that patients should be given an option and fully informed of the drug's potential side-effects; just telling them "it's just something to relax you" isn't enough, in my opinion.....
    neveragain likes this.
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    I fully agree that informed consent usually does not live up to its name. Patients are told "Here's the form to sign so the doctor can give you something to keep you comfy" and that's about it. I try to explain what drugs I'm giving and what they do (including amnesia) but I have about 5 minutes with the patient before they get the drugs, and a lot to do in that 5 minutes. The intake nurses are the ones that have to do it, and they aren't educating the patients on what moderate sedation really is.
    neveragain and darne20 like this.
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    Yup, I remember my first time at a new outpatient facility, the consent form was on the computer monitor which they turned around to face you and you signed on a pad w/one of these special pens like you do w/many credit card purchases - the only problem was only half of the consent from appeared on the monitor w/no access to the mouse to scroll down to see the full consent you were supposed to sign. I did ask that they scroll down the screen and did point out my objections to the manner in which it was presented. I was pleasant about it but it was a definite shortcoming and I felt I should point it out.
    darne20 likes this.
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    Bootynurse and ChronieToo-both of you are 100% correct. I just had my yearly colonoscopy and I was curious about how "informed consent" was done. The GI doc (she is very nice, and know that I don't do sedation) had no problem with doing the exam without sedation; actually, she was quiet honest that sedation was often "demanded" by patients, but from her perspective it's quite optional and adds a lot to the risk and cost of a simple procedure. When I reported for the procedure, I got the "sign here so the doc can make you comfy" line, and the nurses inolved got a little upset when I refused. One even told me to sign a sedation consent "just in case you change your mind"..which I would never do do to previous horrible experiences with Versed and with poorly administered propofol. Just like BootyNurse had said, informed consent was never even attempted and questions were shrugged off.....But I must say, that despite this, everyone was nice and the exam was done, a little uncomfortable, but fine. While waiting for my exam, I heard a patient crying, moaning and begging for the endo doc to abort her procedure; she was given Versed and some fentanyland is a basket case from the amnesia and bad Versed experience. My GI doc has FAP (familial adanematous polyposis-sp?) and gets yearly exams and she always specifies "no sedation".....
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    Ha! No wonder your gastro understood and respected your request for no sedation so well! My gastro and I had a bit of a "stand-off" about no sedation but being the good sport she is she underwent both an upper endoscopcy and a colonoscopy w/o sedation herself before she would agree to do mine w/o - and she later agreed w/me that the upper endoscopy w/o sedation was WORSE than the colonoscopy due to the gag reflex. But it took her undergoing the scopes herself before we reached an agreement and I agreed to her doing the scopes. good thing, too, as I was way overdue for my first scope! :bowingpur
    darne20 likes this.
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    ChronieToo-thanks for the insight; I was about 4 years overdue for yearly exam because every place that I tried to have it done insisted that there was not a sedation-free option. It kind of makes you wonder, when the docs and nurses who tell you that sedation is "required", suddenly tell you that they have had theirs without sedation one it's obvious that you are not going to get it! The doc who did mine was great; but she told me that it was her opinion that the exam may be best done with just some fentanyl only, if the patient has a ride. She said that knowing that the exam is uncomfortable for the totally drug-free patient tends to make her rush the exam; she was honest in saying that they only found this out when some insurance companies would not pay for a colonoscopy unless the withdrawl time was more than a certian number of minutes; and most of the ones that they didn't get paid fully were on drug-free patients. That said, she told me that she would always get hers unsedated and that if you go into the exam in the right mindset with a doctor that you trust, that drugs are entirely optional. Additionally, she was saying that they would really like to discontinue Versed for patients who want sedation; too many problems, a few threatened lawsuits, and that they are trying to hire a dedicated CRNA to give Diprivan (propofol) if you want sedation. Much deeper, no creepy amnesia, no hangover, and with the thousands that they do, she believes that the additional cost would only be about $100. Personally, I prefer nothing; but I'm a guy with a straight colon (easy to scope) and I have a doc who actually makes me laugh a little during the exam.
    neveragain likes this.
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    I just had my first colonoscopy. I am posting because I had been petrified about having one for years due to the sedation everyone said I had to have.

    Well, I couldn't convince them to do the procedure without any sedation, so I just hoped for the best. They used propofol and my insurance covers an anesthesiologist. I did much research on propofol and, although there is no reversal agent yet, the reviews were very favorable.

    So I had it at 8 this morning and I am here to say that it was a breeze. I was worried and anxious over nothing. I was out for just a few minutes while the doctor went into my colon, then they brought me around to watch the withdrawel of the scope and the cutting of the polyps. (I did have 6 tiny ones.) It was a simple, easy experience, I recovered immediately. Was a little groggy so took a nap for an hour and woke up fine. All in all, I started to undress at about 8:20 and was in the recovery room just before 9.

    The prep was absolutely horrible. I would not recommend Golytly. It is vile, repulsive, poison, no matter what you use as a flavor enhancement. Next time I am going just with pills. I also recommend eating very lightly for a few days beforehand because I know my expulsion ran clear faster than had I been eatig as usual.
    darne20 likes this.


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