Colonoscopy & Conscious Sedation

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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

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!!!

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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.

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In just about every other country they do this without sedation. One of my fellow GI nurses found her self in one of these countries on her 50th birthday and said she wasn't even offered a Sugar Pill! Where I worked it few and far between and even then often it was medical pros who insisted on no sedation ( control issues?). In these cases the doctors seem to want sedation more for their personal comfort ( one doc voiced feeling uneasy when the patients are talking to during the procedure) than giving the patient the experience they claim they want. The spots that are uncomfortable are going past the sigmid and hepatic flexure for some.

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If conscious sedation has any effect on pain perception during a procedure, why is it so important to have a drug that causes amnesia afterwards?

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Specializes in Nephrology, Cardiology, ER, ICU.

yvonnev - you might want to start a separate thread as this thread is over 10 years old!

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I didn't think twice about taking the Versed. I got nice and loopy, they pushed the scope up my butt, and I watched by ileus schloop around on the monitor.

A friend decided not to have the sedation and made them stop and drug him.

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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.

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Specializes in research.

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......

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Specializes in OR, PACU, GI, med-surg, OB, school nursing.
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.

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Specializes in research.

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.....

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Specializes in OR, PACU, GI, med-surg, OB, school nursing.

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.

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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.

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