Colonoscopy Without Sedation

[bgxyrnf, MSN, RN]

I am sometimes floated to other departments and recently, to the GI lab, where I observed a patient get a colonoscopy without any sedation or pain medications for reasons that I was not clear about.

It was quite honestly a horrifying experience.

The doc had stated that the procedure would be a "quick in-and-out" and that they would stop if the patient wasn't tolerating it well which, from my observer's perspective, the patient wasn't (based on the writhing and groaning and yelling) and yet the doc just continued on, making statements like, "we're almost done" and "ok, we're stopping now," after which the doc would proceed... and ended up examining the entire colon.

I was stunned at the insensitivity of the doc to the patient's obvious suffering and the disingenuous platitudes that seemed to be offered up to the patient. It seemed similar to drilling on someone's tooth sans anesthetic.

The staff didn't seem particularly bothered by the whole proceeding.

Was this an aberration or is it really an acceptable practice to sometimes perform a full colonoscopy without medications?

[brownbook]

Not normal where I work. No idea why this happened. Maybe you can seek out one of the nurses someday and ask why no sedation was used on the case you saw. Occasionally there are good reasons.

[MunoRN, RN]

I've come across a number of Physicians who would prefer to do excruciating procedures without any analgesia or anxiolysis at all, which is why the patient also has a nurse assigned to them, to make sure that doesn't happen.

I've seen Physicians suggest doing this type of procedures without any sedation, I've yet to see a nurse go along with it, it's unfortunate that the GI lab nurses at your facility don't understand the basic requirements of their role.

[MikeyT-c-IV]

I observed a patient get a colonoscopy without any sedation or pain medications for reasons that I was not clear about.

I've only seen this once as its not common practice. In this case the patient did not want any drug.

[bgxyrnf, MSN, RN]

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[LollygaggerRN]

I've assisted with plenty of unsedated colonoscopies. It has always been the patient's choice. Sometimes the patient wants to be able to go to work afterwards or just doesn't like sedation. I've even assisted with a colonoscopy in which a physician was the patient. He rolled off the stretcher afterwards, got dressed and went off on rounds.

If it is the patient's desire to go without sedation I truly feel it is the nurse's role to help them through, not try to convince them to have sedation. I talk with unsedated pts and try to distract them or coach them through Lamaze type breathing. I certainly don't feel as though as I am a bad or unethical nurse because I am assisting a doc with an unsedated procedure.

On the other hand, if the pt desires sedation but we are unable to safely provide enough sedation to keep them comfortable I always step up and ask the pt if they want to continue or come back at a later time with an anesthesiologist. So far they have all chosen to continue and work with me on breathing, etc. Who wants to go through the prep again?

Additionally, it has always been my experience that the docs prefer sedated pts. A napping patient makes it easier on the doc as well. I can't imagine why a doc would request no sedation. Makes no sense to me at all unless they fear the pt is too ill to tolerate the sedation- and why do a procedure on somebody that fragile?

[tara07733]

A couple years ago when my husband was scheduling his first colonoscopy he looked up info on having the procedure done without sedation since he has a fear of being put out. Apparently it's done a lot more often over in Europe than here. He ultimately decided to go with some sedation (doc used versed) and all was well because, honestly, I couldn't imagine my husband having a procedure without some sort of medication to at least decrease the anxiety and sedate even just a little.