Colonoscopy Drugs and alternatives

There are a lot of people who have a bad reaction to Versed. Not just tin foil hat people either. I have noted that people who do not get the amnesia claim that they were immobile, that their blood pressure shot up and that they were NOT relaxed. Their muscles were flaccid, but it was traumatizing to be rendered compliant and incapable of resisting or having their pain addressed. Even people who did get the amneisa have problems with Versed after effects. There are scientific studies which show an INCREASE in implicit memory with Versed even though it pretty much knocks our the EXPLICIT memory. For some people whose brains have (incomplete?) access to implicit memory this drug does cause long term problems. It is just blamed on the patients' life experiences, previous trauma, other drugs etc.

All drugs have a lot of people who have a bad reaction to them. Even if a studied rate of x major side effect is only 0.5%, when you extrapolate for a drug that is probably used 100,000 times a week nationwide, that's still ~500 people each week.

True. The tinfoilers are the ones who claim it is a dangerous poison that should be banned and that it causes permanent and extensive memory loss.

Anecdotal.

Citations to said studies, please.

A spurious claim at best. Citations needed.

I've worked endoscopy for 5-6 years in 3 different facilities in South Florida. First an in hospital endo suite that does both inpatient and outpatient. Later 2 different free standing outpatient endoscopy centers. In the beginning at the hospital we were using mostly moderate sedation with demerol & versed, sometimes propofol by anesthesiologist or CRNA. Demerol & versed worked ok, patients always woke up and said they didn't feel a thing, but often during the actual procedure they were moaning and writhing in pain. I felt like a few of the docs did not wait long enough for the drugs to kick in. Patients took longer to wake up so they were in recovery longer. A few of the docs started using propofol given by anesthesia and quickly realized the patients did better and the procedure was easier & quicker. The patients who had both liked the propofol much better. They were amazed how quickly they were awake. In the year I worked in the hospital endo suite we went from maybe 20% of cases with propofol to about 90%.

In the 2 outpatient centers I have worked in it's almost 100% propofol. Occasionally we would do a case with demerol/versed if the patient was self pay and didn't want to pay for anesthesia. I don't know much about insurance/medicare billing or reimbursement, but it must be covered or we would be getting a lof of complaints. This is in FL, not the Northeast.

Rarely we have a patient that says they don't want any sedation of any kind. When that happens I try to assess the reason they don't want it. Have they had a colonoscopy without sedation before? If so no problem, they know what they're getting into. If they've never had a colonoscopy and insist they don't want sedation then we try to get them to sign the consent anyway and tell them we will only give it if they ask for it during the procedure. Usually a few minutes into the procedure they wind up wanting the sedation. Only one time did I have a patient that absoulutely refused sedation and had never had a colonoscopy. The reason she didn't want it was because she had to be able to drive to pick up her kids from school, there was no one who could pick up the kids for her. She was extremely anxious about the procedure and I had a bad feeling it wasn't going to go well. Well the doc attempted the prodcedure anyway and she cried the whole time. Of course he couldn't get to the cecum because she was too tense and and in too much pain to continue. I tried to comfort her and let her hold my hand, I thought she was going to break it. It was afwful for her and awful to witness. So don't tell me a colonoscopy is not painful. Certianly some people can tolerate the procedure with out any meds, but I feel that is the exception not the rule. When it is my turn it will be propofol all the way.

Actually, I work at an Outpatient Endoscopy Center in the Midwest (Michigan) and our patient's insurance covers the Anesthesia cost for Propofol. (Medicare included.) Of course, the co-pay is higher to cover the fact that Anesthesia fees bring the cost of the whole procedure up, but...it's money very well spent. Our patient's tell us just that, time and time again. They can't believe how quick and painless the whole procedure is. I hope the wave of the future will be to allow Propofol to be used for all scopes, not just in certain parts of the country.

I'm so glad that everything turned out ok. Also I'm glad that someone listened to me and found out that this is NOT a painful procedure and that sedation is totally unnecessary and a total waste of time and money. Pain meds are a good idea, I did both of my tests with 50mgs of demerol. Polyp removal was painless also. It was interesting to watch the test and talk to the Dr and nurses during the procedure. I learned alot.
Kudos to you!!!!!!!

We use Versed and Fentanyl. I have not seen too many patients with major adverse reactions to Versed. Some of these patients do not have amnesia and in a few cases they had a paradoxical reaction to Versed (extreme agitation). I think that a colonoscopy could be done without sedation and even without analgesia only if the endoscopist has an excellent technique.

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum
not totally applicable, but interesting.....