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 Hospital Education Coordinator.

Congrats! Now you have a clean bill of health (I HOPE!) and bragging rights to boot.

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Specializes in ED, pre-hospital medicine and CCT.

I wanted to add my experience from yesterday to the pile. I recently turned 50 so my PCP recommended a screening colonoscopy. No colon CA in my family hx but enough other neoplastic problems to convince me that it was a good idea. I'm a 50 y/o/m RN, EMT-P. I don't like sedation or pain meds stronger than tylenol. Had it for my wisdom teeth extraction years ago and still remeber the nauseated groggy feeling. The center I use doesn't offer propofol. I did a lot of research and decided to do it without any meds.

The 225G miralax and ducolox tab prep was miserable.

I showed up for my appointment and announced that I didn't want the versed/fentanyl. They looked at me like I had three heads. It was way outside of their box. They said it had been done but was very rare. The RN went off to talk to my MD. She came back and told me the Doc would do it but I sould at least have an IV loc in case it was needed during the procedure. I didn't have a problem with that. Other than some cramping and pressure, the procedure was quite tolerable. I worked hard at relaxing. I watched the whole thing on the screen and asked several questions. The staff commented it was odd to have an interactive patient. Lots of bloating cramps when it was over. I obtained instant relief from flatulance that would make a state-fair cow proud. I left the office in two hours feeling great. Don't have to do that again for ten years.

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Specializes in LTC, CPR instructor, First aid instructor..

All of you who can tolerate Versed in order to have a colonoscopy performed are fortunate. I'm not even able to have one even though my grandmother had colon cancer.

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I have been in GI nursing sine 1989. Rarely are there sedation problems on a patient in generally good health. Everyone has different anatomy. I have seen a ccum reached in a minute. I have seen a tortuous colon that is difficult to navigate and take longer to reach te cecum. You ultimatly hav the decision. I have had the experience of a GI doctor refusing to do a patient not sedated. Good luck to you! Tess

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I think that anatomy and operator skill has a lot to do with complete/incomplete colonoscopies rather than sedation. I could make a good living just providing propofol sedation for colonoscopies; I just don't think that it's necessary to add many hundreds of dollars to the procedure just for sedation. I was an "insider" when I got mine (anes provider) and basically told the GI doc that I didn't want drugs. She agreed and it wasn't bad. The sedation/no sedation issue should be decided before the patient gets to the endo suite. I watched one endo doc squirt 5mg of midazolam into a patients IV as if he was flushing a heparin lock; no titration at all. And then they wonder why the patient has nightmares and memory loss longterm. The GI nurses usually get the sedation right; the GI docs are terrible.

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on monday i had my long overdue first colonoscopy and everything went very well, even the prep was not that bad.

at the consultation the gastro explained every aspect of the procedure (including the negatives) and patiently answered my many questions. we discussed my phobia about being sedated and this caring doctor said he would work with me to do the procedure unsedated, but we aggreed that he would give me propofol (the only med he uses) if things became too uncomfortable.

on the day of the procedure the nurses tried talking me into sedation and the anesthesiologist also did not think it was possible without meds - saying i’m here when you need me. i stuck to my guns and i am so glad i did. during my un-sedated procedure i certainly never felt any pain and i really can't say i was uncomfortable either. for me, the procedure was comparable to the feeling of gnawing/growling one feels when very hungry – this did not even reach the level of discomfort. i was not ‘toughing it out’, or being brave – there was nothing to be brave about as there was no pain whatsoever. the doctor and i talked all through the procedure. he was amazed that i was so comfortable and said i was now his poster child (at 61!)for un-sedated c.scopies and he will reconsider having meds for his own c.scopy, after seeing how well it went for me. all credit goes to this caring doctor, who took 40 minutes to do the procedure, for a completely painless and discomfort-free colonoscopy.

two polyps were found and removed and to my surprise i was also found to have diverticulosis. whether you have your colonoscopy with or without sedation is your choice, the important thing is to have the procedure. it could save your life - it may well have saved mine! i will see my gastro in five years for a repeat performance!

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