Conscious Sedation for Colonoscopy

subee, MSN, CRNA · May 25, 2009

I'm a CRNA and do a lot of sedations for endoscopy. I've only seen one patient who had a colonoscopy with nothing - she was 75 years old and had a fear of anesthesia. Yes, it is possible to have a colonoscopy without sedation but it sure isn't comfortable. As long as you can lie still in case a polyp has to be removed, you'll be fine. Patients who are highly motivated not to receive sedation usually do well. I've often thought of this "revenue driver" idea that you mention and yes, endoscopy is revenue for my group BUT, when a an endoscopist is doing 10 to 18 cases a day (the usual for us), we don't have time to accommodate squirming, miserable patients. I had a patient who had a colonoscopy without any anesthesia in Canada and it took her 14 years to come for another one and she had a history of colitis! We use only propofol and a whiff of fentanyl and I've never seen a parodoxical reaction (more often happens with versed). The procedure takes about 15 minutes if its just a look-see and you can add two or three minutes for each polyp that hadsto be removed. Some patients have insurances that won't cover anesthesia services in an out-patient setting and they get versed and fentanyl and do fine. If your endoscopist won't do the procedure without sedation, find one who will. Whatever you decide, get it done. It's very rewarding when we get a "save" and it happens daily.

regnart · May 27, 2009

Hi,

I had a full endoscopy done (mouth to to the rectum) at the Brigham in Boston a few years ago, and was allowed to remain awake throughout. I agreed to accept sedation if my reactions interfered with the MD's efforts, but it worked out fine. The worst part was when they were examining my stomach - as they manipulated the scope I felt waves of nausea and began reflexively to heave. Once the the scope was advanced beyond the stomach it was no big deal at all, they even snipped off a polyp thingy at one point and I barely felt anything. I found it fascinating watching the video of the transit through my gut.

Good luck,

Lesley

Qwiigley, BSN, MSN, DNP, RN, CRNA · May 29, 2009

Everyone's tolerance is different. I, too, have done a lot of colonoscopies for people with propofol (I don't give narcotics or versed) since out program is called, "Fast Track" and propofol goes out of your body so quickly, the post op is a breeze. I've had all that I can remember (could be 100%) very happy and relieved that it was so easy.

The first response to this added good information.