Colonoscopy & Conscious Sedation

Specialties Gastroenterology

Published

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 is placed. If I can do self hypnosis and tolerate dental procedures, MRI, Epidural Steroid Infusions, I think I can handle the scope insertion. Please give me your collegial / professional experience with patients who refuse sedation and outcomes; also, why do you think sedation is required for this procedure.? I think it is a revenue generator because I have this conflict on sedation for nearly every out patient procedure. Perhaps I'm wrong. Glenn

Specializes in research.

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".....

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

Specializes in research.

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.

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.

There are some modest studies, via Google (ask "acupuncture for colonoscopy") that showed some positive results in relief of fear and pain associated with colonoscopies.

I have benefited from Acupuncture with pain reduction for knee problems (and complete relief from seasonal allergies)

Does anyone onboard know if anyone is using Acupuncture as a type of anesthesia for colonoscopies? Thank you

Anyone on board have info about the use of acupuncture for pain managemet/anxiety control during a colonoscopy?

Acupuncture has a long history of anesthesia use, esp in China, and is becoming more mainstream for use in certain conditions (personally had good pain relief for knee pain due to torn meniscus).

I am not an acupuncturist...I am due for a colonoscopy, have had prior colonoscopies...I doubt it is done, but am posing the question.

Specializes in research.

JB-I have had acupuncture a number of times for dental surgery in the Far East and it worked great; I'm no expert but I would guess that it could be used for endoscopy as well, but I doubt that you have an easy time finding an endoscopist who will take the time to consider your request. I had a difficult time finding someone who would even do an unsedated colonoscopy (even though this is the safest option and the norm in most parts of the world); it seems like most GI docs are interested in the assembly-line approach to this procedure and do not appreciate a patient who wants to participate in his or her care. Three GI docs whom I spoke with "insisted" on sedation (they usually use midazolam) initially; when I told them that I was a hospital pharmacist they immediately changed their tune and acknowledged that a fair number of patients have fairly terrible experiences with midazolam and that they would personally only have the exam with propofol or even unsedated. And everyone admitted that drugs increase the chance of peroration (you won't get perforated if you are unsedated and probably won't with accupuncture either), but this option is a "secret" because it takes a few minutes longer to do the exam. If this sounds like a dismal assesment of the usual way that colonoscopy is performed in this country, it is. Not a rant against midazolam (versed), which has way too many problems to be so widely used, but it's criticism of a lack of informed consent and cost-containment at the expense of patient care. I did find a wonderful GI doc who did the exam unsedated; I'm sure that she would let you do it with accupuncture if you wanted to bring the acupuncturist...but doctors like her are few and far between. Read the anesthesia section on allexperts, Dr J. Starkman's comments to a colonoscopy sedation with midazolam question..his comments about "weeklong amnesia" etc. ring all too true with the patients whom I talk to. You are not unreasonable in requesting alternatives to the sedation drugs currently being used for colonoscopy. Not by a long shot. Good luck.

thanks for such a excellent review/response to my query. I am not having much success in matching an acupuncturist with a GI doc, and I am seeking info from both fields...I will keep you informed if I find items of interest.

Quote: "it seems like most GI docs are interested in the assembly-line approach to this procedure and do not appreciate a patient who wants to participate in his or her care. Three GI docs whom I spoke with "insisted" on sedation (they usually use midazolam) initially; when I told them that I was a hospital pharmacist they immediately changed their tune and acknowledged that a fair number of patients have fairly terrible experiences with midazolam and that they would personally only have the exam with propofol or even unsedated. And everyone admitted that drugs increase the chance of peroration (you won't get perforated if you are unsedated and probably won't with accupuncture either), but this option is a "secret" because it takes a few minutes longer to do the exam. "

This is the word that needs to get out. Versed is way over used and barbaric. I wish this drug were outlawed. It has been in a few hospitals and some doctors will no longer use it. It will NEVER be used on me or anyone I care about. As was mentioned, it is so widely used in colonoscopy because the doc wants to rush through it. Its like herding cattle all day.

Robert

In our area our gastros see patients in their office ONE DAY a week! Three days a week they are doing scopes at one of two local hospitals and a free standing endosocpy facility. None are available on Fridays. If they insist on two "well visits" a year w/their patients WHEN does that leave them TIME to ADEQUATELY treat their Crohn's disease patients w/active disease or patients w/other disorders who need attention NOW or at least w/in a reasonable 2-3 days wait???

Thank you to robert and chronie,

In over a year, I have not been able to find anyone who will allow an acupuncturist to do any treatment during a colonoscopy.

I have refused Versed, after one experience with it, and it was not explained to me that I would lose memory of the procedure. I was home, and had to call the office to ask - how did the scope go? am I ok? When I learned that Versed caused me to be so unknowing - I would not take it again, as I am a single individual who has no family.For a subsequent procedure, I have met with doctors who exclaimed: refuse Versed? you are much stronger than I am...I would never do that, etc.

In one situation where I refused Versed, I asked for Demerol instead...They said they gave it, but it didn't help at all. The doc was angry..."next time we will put you under anesthesia"....And I won't do that, surely...

This bulletin board helps me remain steadfast in my determination to be as much of a self-advocate, as I can be, in this wide world of health care.

Hi Nurses,

I am not a nurse but read your thread and thought you might be interested in my take on this topic. I'm a 52 year old man who had his first colonoscopy yesterday. I did not know the doctor but as he was about to sedate me I asked if he could give me a low dose so that I might watch part of the procedure on the monitor. I told him I was very interested in being awake and observing. To my surprise, he asked me if I wanted to try the procedure without sedation and that both he and the assisting nurse had done it. I said sure and he assured me all I had to do was ask and he would turn on the IV sedation. While the procedure was quite uncomfortable and at times down right painful, I totally enjoyed the experience. I know it probably took him a little extra time and I thanked him for it. I will also write my primary care doc and tell him how much I appreciate the GI doc and his willingness to work with me. He used CO2 gas and I was very comfortable within a few minutes of the removal of the scope. Both he and his nurse were very supportive throughout the entire experience and I will recommend him to my friends who need the 50 year old checkup.

jvj

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