Colonoscopy sedation

Does anyone have any experience with this (and similar procedures) and having laughing gas/nitrous oxide/entonox as the sedation?

It is possible here in Sweden and Finland but not heard any experiences and as the procedure is a possibility then I might want gas - hate needles and would prefer to be more awake.

icosm

though must admit from a personal perspective the idea of the mask is something that might just make this "more" tolerable or even to a degree pleasurable than it might be - this scares me as now my fetish starts mixing with real-life...hmmmm

I never heard of using nitrous oxide sedation for colonoscopies in the U.S. or anywhere else for that matter.

It's only one needle. You have obviously had them before.

Look away when they do it. Suck it up and do it like everyone else. 😁 😁 😁 😁

[quote author=Switchablesusie link=topic=38318.msg326749#msg326749 date=1291984128]

I never heard of that in the U.S. or anywhere else for that matter.

[/quote]

Switchbladesusie, you're generally spot-on accurate, but I think you're incorrect in this case.

In some parts of the world--including I think somewhere in Scandinavia--they routinely do them without sedation, so I can imagine them using nitrous. I remember a conversation online (in a medical forum) where someone from that country laughed at wimpy Americans who need sedation.

I counted yesterday as I was in the endoscopy lab waiting while someone else had a scope--first time it's not been "my ass on the line" and I can count 11 scopes I've had, though it might be more.

Last time, I talked them into using light sedation, and apparently I moaned enough that eventually I gave them permission to knock me out more. I remember the GI asking my permission and hearing myself give it. I enjoyed my first 'scope, and ever since then I've been trying to get back there...never can.

The issue is the speed and care with which they do the scope. Where they don't use it, they take their time and in most people without significant intestinal disease or scarring, they can do it with no sedation.

But in many countries, including here in the US, they are in a hurry and want to get as many scopes done and dictated per hour as possible. So they use more air, inflate the colon faster, and rush through the procedure.

A colonoscopy ties up an expensive procedure room, the scope, the GI, at least one nurse and one tech, so it costs a lot per-hour where things are billed that way. So an unsedated colonoscopy in the US really is far more painful than one in, say Sweden. Unless you have a GI who owns their own lab, then they can take their time.

Bravo Carrfear. You are absolutely correct that Colonoscopy without sedation is possible in most patients, provided the examination is not rushed by time constraints. In a busy GI Unit they really don't have the time due to business managers and the fact the physician is usually paid by the procedure rather than by the hour. Many patients expect to feel the least possible discomfort, if any at all, so there is an added incentive to use sedation as routine. The fault really lies on both sides, but it also goes on the premise "That's the way we have always done it so why would we change now".

Current scope technology has evolved for decades and today's instruments are much more compliant and resilient than the early days when the procedure was first introduced and Conscious Sedation became the standard. Older scopes were relatively stiff and caused quite a bit of pressure while bending through the splenic and hepatic flexures. Now scopes are almost as soft as a wet noodle and better conform to the patient's natural shape rather than straightening them out as the older ones did.

In the old days the routine was a shot of Meperidine (Demoral) IM for pain control, and then 10mg of Diazepam (Valium) IV to sedate the patient just before the procedure. At the time Roche produced Diazepam for IV injection at 5mg/cc in 2cc pre-filled syringes specifically for endoscopy users. Along the way it was noticed that the Valium induced a short-term amnesia of the procedure and in most cases, if the patient felt any pain or discomfort they often didn't remember it. Some brilliant (twisted?) mind thought that was the most important factor with sedation and today a lovely drug known as Versed will turn anyone into a total submissive and obliterate most memories of the procedure, even though it does little for pain relief. The perfect tool for a production line, Dope em and Scope em.

Numerous studies and papers have been published on alternative sedation for Colonoscopy. None which I have read found that NO2 was a suitable pain relief agent and only if the patient was fully unconscious was it found to be beneficial. I would expect that if the patient was marginally able to tolerate the procedure mild Nitrous/O2 would take the edge off. A major safety concern would be that most endoscopy equipment is labeled not suitable for use with flammable anesthetics, and NO2 with O2 is definitely a flammable anesthetic.

One thing to note is that Colonoscopy is normally painful ONLY during the introduction. The objective is to make a full intubation, as quickly as possible preferably, and then to actually examine the colon during withdrawal. Once the scope has reached the maximum distance, the remainder of the exam is almost painless and many patients say they can't tell how far the scope is still in at any particular point. So other than the few minutes required for insertion, the remainder of the procedure requires no sedation at all for most patients.

I did my last one without sedation. It was painless going in and coming out. I did it because I right afterword and had to drive. I will never go with the sedation again. You have already destroyed the day before why destroy the day of the procedure with driving restricitions.

The Doctor gave me the guided tour....not that I will ever use the informatiom. It was interesting.

Hello course,

Where did you have your scope without sedation? The VA knocks out people to trim their toe nails!

Where did you have your scope without sedation? The VA knocks out people to trim their toe nails!

Here in Florida. My Doctor told me he has more and more people every year doing wiyhout. About five years one of the insurance companies refuse to pay for sedation, that where I got the idea. I researched it online and found there are alot of Doctors and patients going this route. I thing the insurance company was Atena.....they have now relented. I assure you it was painless.........I am a devout coward.

It's just down to finding a doctor willing to do it...takes longer, so "costs more".

For me the cost was the same. There was no sharing with the anesthesiologist. I cannot speak for anywhere else.

Course

I have an appointment for a colonoscopy in two days. It's my third in six years, and here I always have the choice of doing it with or without sedation. The first two times I went with sedation (it's only a mild sedative with pain relieve, the call it "Sedoanalgesis"), but this time I am really thinking of trying without, because I want to follow the exam on the monitor.

I have ordered the full colonoscopy up to the cecum, and I am just not sure of there is any pain involved, or not. With sedation I was not knocked out completely, but could barely remember the procedure afterwards. It may have been uncomfortable at times, when getting blown up with air, but that should not be such a big deal (being accustomed to enemas up to 3 quarts).

On one hand I am curious enough to see my colon live on screen, on the other hand I really liked the sedation as well (just such a different feeling than under influence of alcohol).

Well, I have to come to a decision by Tuesday morning, and I still have no clue which way to go...

Well I have a such good remembering of my colonoscopy , nothing because sedative , I will ask the record of the video on a CD .

So I will see my colon , and I will feel nothing .

Pleasure and knowledge .

Sounds great, let us know how it turns out. Of course with my big buthole you could drive a truck through to my tonsils.

Actually my wife has always told me I was a perfect asshole anyway.

I have an appointment for a colonoscopy in two days. It's my third in six years, and here I always have the choice of doing it with or without sedation. The first two times I went with sedation (it's only a mild sedative with pain relieve, the call it "Sedoanalgesis"), but this time I am really thinking of trying without, because I want to follow the exam on the monitor.

If it makes you feel better I was shown my appendix on the "guided tour". I don't think they can go any further.

Course

If it makes you feel better I was shown my appendix on the "guided tour". I don't think they can go any further.

Actually they can go quite a bit further. Once redundant loops are removed after the colonoscope has reached the cecum (and appendix), usually there is 30cm (12 inches) or more of scope length still available. If the ileocecal valve is being cooperative and opens on stimulation, the endoscopist may be able to intubate into the ileum the full length of the scope. Most colonoscopes are between 165cm and 180cm in length.

The ileum may be examined further by a procedure known as Retrograde Small Bowel Enteroscopy. An enteroscope is thinner and even more flexible than a colonoscope, however it lacks sufficient rigidity to transmit the shaft torque the 220cm or more in length. To compensate for this, once the enteroscope has been advanced to the cecum, a 150cm or longer semi-flexible plastic sleeve with slightly larger outside diameter than a colonoscope, over the shaft of the scope, is introduced through the colon up to the cecum. As the overtube is positioned in the cecum, a balloon on the tip is inflated to maintain its position in the colon. The balloon on the overtube creates a seal against the walls of the colon allowing the cecum to be pressurized with insufflated air, forcing the ileocecal valve to fully dilate. The scope is then advanced through the ileocecal valve into the ileum as far as possible. At this point a balloon on the tip of the enteroscope may be inflated to maintain the tip position within the bowel, and then the scope is withdrawn a short distance, pulling the bowel backwards. In a manner like a caterpillar moves, the overtube balloon is then deflated, the overtube is advanced into the ileum to catch up to the tip of the scope, and then its balloon is reinflated. The scope balloon is then deflated before advancing the scope further. By repeatedly doing this, literally feet of small bowel may be "pleated" onto the overtube, allowing examination and therapeutic maneuvers far beyond the length of the scope, 300cm (10 feet) or more.

While you may or may not be able to tolerate a colonoscopy without sedation, very few people could withstand the abdominal pain of a Retrograde Small Bowel Enteroscopy without deep sedation or general anesthesia. The procedure may also require two to three times as long as a colonoscopy, which in itself would exceed most patients tolerance without sedation.

Without sedation, it's definitely uncomfortable and even hurts at some points. It forces doctors to slow down, which of course, costs them, but it lowers the chance of them perforating your bowel wall. Most doctors are not very willing to do it, but if you really insist, they probably will.

Well, I had my colonoscopy yesterday. I was indecisive about sedation till the last moment, but then finally have been bold enough to go without. What can I say, it was AMAZING!

They even didn't set an IV, although I had the option to get sedation during the procedure, if it should have gotten unbearable.

I'm glad, that I didn't get an erection, because when the doctor lubed my anus, stuck a finger into my butt, and moved it around to check if everything is clear, I got slightly excited.

The endoscope went in, I was first laying on my left side, then on my back, watching it go through my colon up to the cecum on the monitor without any problem. There was no pain or discomfort at all (I guess that's the major advantage of being used to large enemas). Took a good look at the cecum and ileocecal valve, then the endoscope was slowly retracted, while every inch of my large intestine was carefully checked for abnormalities. Not much air was blown in, but water to further clean out some residue, which then got sucked away through the scope. Everything was just fine, nothing abnormal found, except a slight inflammation in the rectum, from which two tissue samples were taken, but the doctor assured me that this is nothing to be worried about. He also mentioned that I have a pretty long colon (but no megacolon), and he suggested a revisit in 4 years.

The endoscope went out, and I was ready to go. I even didn't pass any gas afterwards or had a bloated belly, much like nothing happened.

It was a fabulous experience, and I will never ever go for sedation for a colonoscopy again. 😃

Here is an account of my recent unsedated colonoscopy.

I followed the Doctor into Procedure Room 2 looking at everything and trying to take in as much information as I could. Already in the room two female nurses with their backs to me were chatting and getting the drugs and equipment ready. Two are required for colonoscopy, one to care for the patient during the procedure and one to assist the endoscopist (the doctor) who needs both hands to operate the colonoscope. The Doctor indicated that I was to sit facing him on the edge of the examination trolley which I did. The colonoscope, far from being kept out of sight as some authors recommend, was right in front of me so I was able to take a quick look at it. As far as I could tell it was a standard 160cm. adult model with insertion depth marks at 100mm. intervals along the shaft. I’m certainly glad I had done my homework; to see one for the first time minutes before it goes into you must be more than a bit frightening. He checked that I had read, understood and signed the consent form and asked if I had any further questions. I reiterated what I had told the admission nurse about not wanting midazolam sedation and he readily agreed. I said I was quite happy to have the fentanyl. He then put a band round my right upper arm and told me to squeeze my fingers a few times. I watched as he expertly slid the cannula into a vein in the back of my right hand and pulled the stopper from it until a drop of blood oozed out. As an aside he asked the nurses for 20mg. of buscopan. Knowing that buscopan is simply to relax the bowel muscles and that 20mg. is the standard dose (which I had had with my barium enema) I said nothing.

Now it began. I was helped onto the table by one of the nurses and laid on my left side with my knees drawn up and the hospital gown parted. A small blood-oxygen saturation monitoring device was clipped to one of the fingers of my right hand and rather to my surprise an oxygen supply via a plug like an earplug was somewhat roughly pushed into my right nostril. In front of my face was the stand with the monitoring device on it so through the side rails of the table I was able to see my readings displayed and above the middle of the table was the large video screen so I would be able to see perfectly the images from the camera inside me. The nurses were chatting away about their families and so on whilst the Doctor began injecting the three drugs into my hand. I could see perfectly the labelling on each syringe and the graduated amounts as he carefully put them in; first 50micrograms of fentanyl (half the 100 microgram syringe-full dose I had expected) followed by the 20mg. of buscopan with an explanation “this is to relax your bowel”. I felt nothing in my hand and nothing went to my head as I had half expected.

I think it was at this stage that the table was raised up to about 1 metre height, the room lighting turned down and the examination proper began. I looked at my watch which I had twisted round to the side of my left wrist facing me. It was 2.50pm. I had a piece of kitchen roll in my hand in case I needed to blow my nose or wipe my eyes. The first thing I felt was the doctor’s finger lubricating my back passage and then the instrument being pushed inside. Immediately there was the view inside my rectum on the video screen, so far so good. No pain at first, just the feeling one would expect with something like that in one’s rectum. I could feel air being pumped in and the tip of the scope moving up and into my sigmoid flexure. Almost immediately the Doctor pointed out to me a small polyp on the screen. It was about 3mm across and I watched but felt nothing as it was cut out and cauterised via the end of the scope. He then began to advance the scope up my left side. The only pain, which was just a sort of aching discomfort similar to normal wind pains came when the tip of the scope reached the splenic flexure just below my left ribs. The actual site of the pain was just to the left of my navel. I told them it was starting to hurt a bit and the nurse standing at my head said it was going round “a sharp bend” I could see it on the screen and asked if it was the splenic flexure which one of them confirmed. The pain receded again.

As I had expected at some point, the Doctor then asked me to roll onto my back. I don’t recall whether or not a nurse covered me over. I could still see the screen which was now showing the distinctive triangular lumen of the transverse colon. It was a strange sensation feeling the pushing of the tube right inside me. I remarked on the triangular appearance and one of the nurses said that everyone was different and triangular didn’t always mean the transverse. Then back on my left side again and then face down for a short time. That was a bit tricky because of the oxygen monitor clipped to the middle finger of my right hand. The nurse adjusted things. Finally back onto my left side and the Doctor pointed out to me the end of my colon (caecum with appendix which I clearly saw) and the ileocaecal valve at the exit from the small bowel. To push the instrument all the way around to the far end of the colon had taken just about 10 minutes according to my watch and hopefully the discomfort, such as it had been, was over.

The actual inspection of the bowel lining is done whilst withdrawing the scope and this now began. I watched fascinated as biopsies were taken from the wall of the colon at intervals which he called out to the nurse assisting him. I think she was feeding the snipping jaws of the biopsy forceps device through the scope and retrieving the samples into phials for analysis. I saw that each time one was chopped out by the jaws the site immediately bled and then the scope was pulled back and on to the next site. After the first lot of biopsies in my right colon he pointed out the visible blue shape of my liver at the hepatic flexure. As the scope was withdrawn through my transverse colon I could see a noticeable amount of residual yellowish brown liquid and commented that it didn’t seem as clean as I had expected but he said it was fine. More biopsy samples were taken from the left side and then some from the rectum. The final check, just as I had expected, done immediately before the last few inches of the instrument are slid out from the anus, involved hooking the tip right over so that it was looking at the anus from the inside and then twisting the shaft through 360 degrees. It sounds a bit drastic but it didn’t hurt. I said “that is amazing” as the screen showed all the veins above my anus. How many people can say they have seen their own anus from the inside? The instrument was pulled out and the trolley lowered. The whole thing had taken 20 minutes of which the scope was in for 15 minutes. The Doctor said he would talk to me later and I was pushed on the trolley out of the room towards the recovery ward virtually opposite.

I had a colonoscopy last year. The Dr absolutely refused to do it without a general anesthetic and a designated driver for afterwards. (Turns out the anesthesiologist is a partner of his) Also he demanded the polyglycol laxative the day before and no enemas allowed. While I was out, he found a "suspicious" polyp. Surprise, surprise, it came back from pathology as "possibly pre-malignant." So now I'm supposed to return every year for a repeat. And to top it all off, I got a wicked UTI. Hmmm.

I'm finding another GI specialist for this next one! And I WILL be awake.

My unsedated colonoscopy went just that way except no drugs at all and no rolling around; just on my left side the whole time. I felt nothing at all. When he got to the final bend he had the nurse and tech push on my right back and front for a few seconds until the scope went around the bend. The tech operated the jaw looking device as he took samples. It is pretty incredible how much stuff they get inside that tube. Light, water tube ,gas tube, and sampling. I also think there is something that lets the doctor manipulate the end of the scope. It was interesting looking at my insides.

I wish I had.. My last 3 colonoscopies were were very painful once the scope reached about the halfway point. It seems that my colon takes a very sharp bend at that point and not the "gentle" curve that is "normal."

I had a colonoscopy with NO sedation because I requested such and the doctor was very patient and allowed me to watch the screen the entire time. All painless and no erection as I feared might happen, being fully awake. He said I had a perfectly healthy colon!

I was doped up for my last one. In the recovery area, I still had the pulse ox gizmo on my finger. The nurse asked if I wanted anything. I asked for a coffee with cream and sugar. She gave it to me and I don't remember much else. But later my wife informed me that I stuck the finger with the pulse ox device on it into the coffee to stir it.

Don't think they want me to come back.

I've had one "flex-sig", which examined only the last 18 inches or so of the colon, and one "ful dressl" colonoscopy.

The former didn't amout to much; the MD informed me that no "prep" other than a couple of Fleets, immediately before the study, would be necessary. The whole thing took more than five minutes, and the clinic involved always left a "scope" out in plain view, so that the patient would feel at ease.

That was over ten years ago, in another part of the country (Omaha, Neb.). When another exam was required three years ago, the "rules" had changed considerably. I was told that the rationale was that the simple "flex-sig" didn't (literally!) go far enough, and had fallen out of favor just about everywhere. But at the same time, the slow-developing pattern for most polyps would, in the absence of a family history of colon cancer, allow a single colonoscopy to suffice for a ten-year period.

The test was authorized by a GP, and not connected to any specific problem, and I was given a choice of three locations. I made it clear, partly out of a sense of curiosity, and partially due to the fact that I lived independently and would have difficulty finding a driver, that I would prefer to decline sedation. That limited my choice to a hospital, rather than an "endoscopy center", but the MD agreed, with the understanding that if any major discomfort arose, I would submit to sedation immediately, and forefit all further control over the process.

Although I self-administered a couple of enemas, including glycerine and the notorious "milk-and-molasses" about 16 hours before "the event", I was still passing some solids the night before the study, so I started downing the recommended "HalfLytely" that evining, and was passing nothing but a clear yellowish (due to liver bile) fluid after only the third glass.

The 'scopy itself was a piece of cake, I felt only a slight discomfort when the scope was eased around the two major curves in the colon, and some pressure applied from the outside by the two assistants in charge took care of that. The MD running the show had enough of a sense of humor to recognize that part of my motivation was the need for a good "bar bet" -- Think you've gotten around, buddy? --- Well, I've made one trip I don't think you have! ( 😄 😃 ).

And I was able to drive home on my own at rhe end of that unusual trip.

I had a full colonoscopy a couple of years ago, and refused anesthesia. I found the picture on the monitor to be just fascinating. After all the joy the inside of my colon has brought me across the years, it was nice to finally see it. The scope did hurt, briefly hurt like hell, going through the sigmoid, but once the scope was up into my descending colon, from there on the whole procedure was painless and interesting.

Hugs,

Diane

Used to enjoy watching mine and wud ask for very light anesthesia; however, Docs now want a higher degree of relaxation so, 'the show" is over. Last time I did get to see the view when they were 'exiting'

I had an IV and didn't know anything about my procedure.

Being one who was always more frightened by the prospect of being sedated for a colonoscopy than for the actual procedure I have to say I was very pleasantly surprised. Having received ether as an anesthetic for a tonsilectomy as a child left my with nasty memories of what it was like to be put out. Of course today's anesthetics are nothing like what getting a mask saturated with ether forced over one's nose and mouth years ago.

The sedation for the colonoscopy is really very gentle, administered via an IV and you take a quick nap which leaves you a little disoriented when you come out of it a few minutes later (hence the have someone with you to drive you home) but within a couple of hours all effects of it are gone. (Having someone with you to sit in while the doctor gives you the results is helpful too as you may have a little difficulty in remembering all that you are told right after the procedure)

I received IV sedation. Remember watching the syringe go in then the foogy feeling talking to the doc. Quick and painless.

I'm 20 in 6 days, and I've had four colonoscopies in my time. I have been under, what my doctor calls, "Twilight Sedation" for all four. I generally don't mind because all I can focus on is the ravenous growl from my stomach from the 24-hour fast. My GI always prints out pictures of my intestines and gives them to me. I also like the feeling when I'm first being sedated. I'm just happy and content.

I did one a few years ago and the doctor was willing to give me any level of sedation I wanted. His only requirement was that I have an IV put in first so that if I had a problem and wanted more relief from pain it would not delay the procedure.

I ended up having a very light sedation to take the edge off. In retrospect none would have been OK. As it was I was fully awake throughout the procedure and remembered it clearly afterwards. It was actually quite fascinating -- kind of like a Walt Disney movie of a journey into a whale stomach! I really enjoyed watching the whole thing on the high def monitor.

The reason I did it "awake" is that 2 friends had done it that way and said it was no problem. As it was, by having some sedation I was not supposed to drive for the rest of the day (though I did later). When I do another I will try to not have any sedation since then there will be no restriction on driving.

As it was I have had much worse procedures with no sedation offered.