Colonoscopy sedation

I'm having my first colonoscopy on June 29 and I plan on taking full advantage of the versed/fentanyl cocktail. I have a very high pain tolerance but this is really something I don't want to know about. And although I'm an avid student of anatomy and physiology, I'm really not interested in pictures or DVD's of my innards. Just let me know if the procedure was clear, or if there's a problem that needs dealing with.

Just my 2 cents.

I have had two in my life and both were fully sedated. I was a bit disappointed the first time. Wishing I could experience more. I am over that now. I would not be at all concerned if I was you.Good Luck if you have not had the procdure yet.

I was awake and watched the TV monitor the whole time. Interesting, but not exciting. It would have been better if the DR doing the procedure had been a nice looking female instead of an old fart male.

I am age 54 and have had two colonoscopy procedures done in the last 10 years. My father's side of the family has a history with colon cancer so at age 45 I had my first one and at age 50 my second. Both times polyps were found that were non-cancerous. However, I did have a problem with the second colonoscopy regarding the sedation...there was too much sedation and for about 2 years I had trouble with my memory and with my speech. As I did my research and talked with a different doctor I realized this is more common than most people realize. When my wife went through the procedure 3 years ago she had a similar response as I did. In talking with dozens of other people I am coming to the belief that it is better to have as minimal sedation as the individual's pain threshold will allow. Discomfort and "strange sensations" can be tolerated better than having memory and speech problems after the event...believe me!!!

Yes, Peterbilt149, I agree it would be better if a nice looking female were on the other end of the snake. Next time ask for a specific nurse to assist and keep your gown down. Another good reason NOT to have too much sedation is that most people talk while sedated and never remember what is said. Nurse friends of mine said that they have "heard it all" while patients are getting a colonoscopy. Gee...now if I could only remember which nurse I had...dang.

In my case they have a person standing by to adminster the sedation if necessary. It has not been necessary so far. I am told to have it done after three years if they find polyps which they did last time. Try to arrange the standby if you can.

Course

I did not use sedation for my last colonoscopy. Several friends did not use sedation and told me the procedure was tolerable without. That includes polyp removal. While getting the scope around the first bend was slightly uncomfortable, the rest was a breeze. I carried on a conversation with the gastro and the nurse throughout and then walked to my car and drove home. I will not use sedation again.

Additionally, I had such a bad experience with the oral lavage for prep the first time, I used enemas and two colonic irrigations for the prep this time. The prep was actually very tolerable and in fact, quite enjoyable and relaxing. The colon hydrotherapist was great and had full understanding of my decision to avoid the oral drain cleaners.

During a conversation with the attending nurse, I told them of the prep method. I had allowed time for my colon to "dry" after the last colonic and aside from a little fluid, the bowel was well prepared. The scope sucked off any excess fluid and all was well in the end...my end that is.

There is certainly wide variation in what people want/expect regarding sedation, which is pretty normal for the human population.

I have been through two colonoscopies - one with just enough painkiller to take the edge off, and one in which the DR. (the first one had moved to a different facility) gave me so much painkiller that I might as well have been sedated. I definitely prefer the first. I feel that if i have to go through this procedure I migtht as well learn as much as I can.

One thing which annoys me is that the information you are given beforehand assumes that you want to be out for this. It is full of phrases like 'little or no recollection of the procedure'. I think it should state that you have a choice, and that there is nothing wrong with making that choice for yourself (in either way). I do agree that an IV should be started just in case there is a problem.

Also I asked for DVD of the procedure and they refused. I would not have minded paying small fee($25) for one, but i guess they want everything that went on to be secret. I am sure they probably have a complete recording of it on a disc somewhere there. Right now I am already trying to figure out how i will find a more cooperative center for the next one in a few years. Any ideas?

I certainly will never let the second Doctor touch me again. It was obvious to me that he just wanted to go as fast as he could, and that he even considered taking time to talk to me a waste of his time.

Lady Docisim, And how did your test go? 06-0602011 I hope it went well for you. I had my first test in 1991 and I went for the surgey, cancer and i keep going for the tests, though not great but needed as they find polips. The was not fun but I am here 20 years later. The good news is that the best cancer to beet. Smiles bobboenem

My appointment isn't until the 29th of this month so I'm still on the edge of my seat, so to speak! My medplay partner will be in town that week for an extended play session and we are going to work the prep and procedure into one of our scenarios. If there is a way to make this fun, we'll find it. I'll update after it's all over and done with.

They do assume you want to be knocked out. I was given versed during my colonoscopy, even after I said I do not want to be fully knocked out. Perhaps I was not fully out, but versed is a mind eraser, so I may as well have been.

When I had knee surgery, I had to be super assertive about the versed. I insisted on an epidural and they were going to slip the mickey as well. I am thinking what is the point of being conscious if I can't recall any of it! I want to see the repair they were doing in my knee. So I had to be very very specific, I want to be lucid..

And so I was 😃

Drglovelover - after you came to did you have any words with the folks who gave you the versed? If so what was their excuse?

Also, boboenem - my first colonoscopy showed one polyp which I watch the doc remove - The second supposedly was clear - however I wonder if I should ever trust the result given the guy's obvious haste. He said come back in 7 years. I am going to try to get someone to redo it in no more than 5. That may be tricky as they will all start saying it isn't medically necessary.

Four times and I have never been sedated. My doctor is an attractive woman; however, I have never had an erection during this. As for being sure everyone knows I don't get sedated, I usually bring my own red felt tip pen and write in bold letters across the Sedation Informed Consent Form "NO SEDATION" and of course don't sign it. That usually pisses off the lady taking the forms. I usually respond by telling them I don't want anyone to be confused about the point of NO SEDATION. I am sorry if she doesn't like it but guess what, this isn't about what make her happy.

I've only had one, but will be getting another this fall (my 3 years are up). I had IV sedation, and the last thing I remember before going out was the nurse (cute, I won't tell her name, but I Do remember it) asking me to scoot my bum out a little farther over the edge of the table. Next I remember was waking up about 45 minutes later, all done, and being helped off the gurney, to get dressed and leave. No pain or anything, already cleaned up (someone did a nice job of that but I have no memories). I think that sedation is the painless way to go; they used something that was apparently very controllable. When started, I was solidly out in about 5 minutes; and I awoke easily, no hangover or anything.

Good luck on yours, if it goes like mine, you'll find it a walk in the park.

Oh, and the super laxative, fasting and water only wasn't enough in my case, the doc complained a little at the post interview that 'things weren't as clean as they could have been', so you might consider, in addition the the rest of the prep, having an enema or two.

Happy waterings,

Cos

Cos, not sure how you got by so nicely but congratulations to you! My first colonoscopy was uneventful except for a few polyps but the sedation did not bother me. The sedation on my second one caused me trouble for some time afterwards -- memory problems etc. That you could remember anything at all must mean that you had a very mild dose of sedative.

Frankly, I'd like to try the colonoscopy someday with little or no sedation and just a "slow hand" at the controls to let me work through the discomfort and occasional pain.

I've had two with sedation. I was awake during both but more to the end, no pun intended, of the procedure. I was not aware of the insertion but was awake later on in the procedure. I thought it was pretty interesting to see inside of my colon and found it to be pretty fascinating experience. I got a very nice report with pictures the first time. Fortunately, all they found were polyps. No memory problems fro the sedation. I will have another one early next year. I might have it without sedation based on everyone's cooments here.

MeOmY:

Re the sedation: They put the IV line in while I was in Admitting, while I was getting undressed and stuff, but it was saline, just to get it started; then once I was admitted into the operating room/treatment room, that's when they added the 'active ingredient' to the IV.

I'm about to schedule my fourth Colonoscopy. The first was part of the diagnostic process for Colon Cancer (I had it). I had sedation and an amnesiac for that one. The next one (clean, so to speak) was done without drugs. No big deal for me but the hospital staff - that was a different matter. It was like they had never had anyone refuse drugs before. For the third, I talked to the Doctor in advance, he was fine with no drugs. I checked with the hospital at the time of scheduling and told them in advance that I would be having no drugs - no objection. The day of the procedure was a totally different thing. The staff insisted - I said no. They said it was procedure - I said no. The nurse called the supervisor, I said talk to the doctor, finally we proceeded. I'm curious to see how it goes this time.

No sedation on both times I went in

It is bereable and less mess

# 5 was just completed. Again it was not without sedation. The nurse and the doctor were great. This was perhaps the best nurse I have had during a colonoscopy. She was doing her job assisting the doctor and at the same time applying pressure when she thought it was needed. At first some of it appeared to be a bit too firm but I realized it was removing the pain from other areas. I would be lying there and start to feel the start of pain like a good enema cramp, she would realize I was starting to feel pain and she would tell me "deep breath". She coached me through it. If she saw me tense-up it was the same thing. "take a deep breath". The doctor took her time but had problems with the colon and scope alignment particularly reaching the cecum. She finally said I needed to shift positions, roll to my back and bring my legs up a bit. She keep my privates covered (darn).

In this position the discomfort dropped to the point the I was feeling the in and out of the scope in my anus as she was I was manipulating it to reach the cecum. I was fully expecting to get an erection; but, I suppose between the age and everything else going on it never happened. Once she reached the cecum, she had me roll back to my side. This one took almost 45 minutes from the time they rolled me in until I was rolled out.

She did tell me that they no longer use the cocktail with Versed. Instead they now use Propofol because it has fewer side effects and the patients are fully alert with they are sent to recovery. I still prefer no sedation. It should be five years before I get to do this again.

Hmmmm, not quite. They can't use Propofol unless there is an anesthetist or a CRNA in the room during the procedure to administer the drug and to monitor you. Also, if your insurance won't cover it, and most won't, no Propofol for you. Propofol is quite costly and given all the other measures that have to be taken to use it, most doctors still use versed/Demerol or versed/Fentanyl.

Lady Doc,

I just had a colonoscopy a few weeks ago. I ask the Nurse what drugs they were going to use and she said Versed/Demerol. I asked her about Propofol and she said in our state, it could not be given except by a doctor who was monitoring the patient. Since the doctor doing the procedure is monitoring the colon and not the patient, there has to be another doctor in the room to use it. So she said that Versed/Demerol is standard in my state for colonoscopies.

LadyDoc.

According to my beautiful GI doc, her facility has almost exclusive gone to Propofol. She and the other doctors in partnership with her own the Endoscopy Center. They depend upon insurance for most payments; so, I will challenge your statement that most insurance companies won't approve Propofol.

They use an anesthesiologist not a CRNA. I counted four GI doctors and four anesthesiologists the day they did mine. Even if I had agreed to sedation, I would not have agreed to a CRNA administering it.

Mine colonoscopy was her first of the day; that way she wouldn't be paying the anesthesiologist to stand around. While in recovery (farting)they brought back the lady my doctor did after me. When they rolled her back to the recovery are next to me area, she was talking about how much easier Propofol was than the Versed and how she was going to IHOP for breakfast. Prior to Friday, you should read more on the side effects of Versed (headaches, memory loss, etc). My brother lost his sense of taste for close to a year after they gave him one of the Versed cocktails.

One of the perks of living near a major city is an abundance of top hospitals and medical people. We are spoiled as we don't have to settle for doctors who took a course in colonoscopy in order to jump on the money train. We are blessed in that there is an abundance of anesthesiologists and CRNAs. Anyone unfortunate enough to be forced to take a narcotic memory altering drug, has my sympathy. Having a choice is a great thing. Many top doctors head to where the income opportunities are greatest and the rest of the hospitals get to settle for those not financially motivated. I love Capitalism.

You say you are "an avid student of anatomy and physiology". Previous colonoscopies without sedation for me usually lasted no more than 30 minutes. This time because she says she wanted to be very gentle, it took 45 minutes. I enjoy seeing the innards. It distracts me and I get to see how good of a job I did cleaning. I have diverticulosis and as such a bit more susceptible to pain. I don't think my pain every exceeded a 5 out of 10 this time. When I first went without sedation 14 years ago, she made me agree to an IV in the arm "just in case". In case I changed my mind or in case something went wrong I needed medication fast. I never understood why a person with a medfet would pass up this opportunity. In my experience the doctor and the nurse control the pain.

Best of luck on yours and I hope all goes well.

Wow Tom! To read your version of it, it's a miracle that a stump-dumb redneck like me has managed to survive the swamp water and whiskey medical system that we have available to us here in the backwoods.

All kidding aside, I respectfully rebut your position regarding payment for propofol in colonoscopy sedation and cite the following:

http://www.anesthesiazone.com/featured-news-article.aspx?id=3050

and

http://medicine.iupui.edu/gast/documents/scrollNews/EffectoftheCMS.PDF

Simply stated, MOST insurance carriers won't cover the use of propofol in colonoscopy sedation because it adds $200 to $1000 to the cost of the procedure, requires extra manpower and monitoring, and is by and large, unnecessary. I have no idea how the endoscopy center you went to is coding their bills in order to get the payers to reimburse, or what special deal they might have worked out with their supplier to reduce the cost to a reasonable level. I strongly suspect that the endoscopy center you went to does not accept Medicare/Medicaid patients because CMS will not cover this type of sedation/anesthesia unless the patient presents as a Category 3 risk. I have a lot of experience with propofol and while I'll be the first to agree that it's a great drug, I know that my insurance carrier wouldn't pay for it in the application we're talking about. Perhaps yours is one of the few that does and that's great. I doubt that I could afford your premiums or your deductible.

As for whether or not to be awake and cognizant during any procedure is a matter of personal choice and consultation with the health care provider. I was wide awake during the birth of my daughter. I chose not to be during the amputation of my leg although I suppose that if I had insisted I could have had an epidural. I had versed AND propofol for the recent removal of parathyroid, thyroid and thymus glands. I don't remember a thing about it and that suits me just fine because waking up from that surgery was one of the most painful experiences I've ever had. I know I won't be offered a choice for my renal transplant, it will be intubation and general anesthesia, and I wouldn't accept an alternative if it was offered.

I am indeed an avid student of anatomy and physiology, in fact I have a degree in the subject. But that's an objective thing. When it comes to me, there are just some things I'd really rather not know about and frankly, my colon is one of them. Medfet has nothing to do with it since I don't sexualize actual medical procedures that are performed on me. Your choice is to be awake and aware during colonoscopy and if that's what you want, more power to you. My choice is otherwise and beyond that, it's nunyadamnbusiness and it's not your place to pass judgment. The differences between us doesn't make our choices any less valid.

As for your advice that I should study up on the effects of versed, I have to say I think I'm pretty familiar with them, I've used it at work every day for almost 15 years. The same is true of propofol, which like any other drug, has its own set of cautionary tales attached (Michael Jackson, anyone?). As for versed, a simple Google search will tell you that it is an amnesiac and by its very action, it causes loss of memory. Anyone who receives versed and doesn't anticipate memory loss hasn't been properly educated and counseled. I've received versed many times and not suffered any ill effects. On the other hand, propofol causes me to become uncontrollably emotional, a side effect that I don't much care for but have learned to anticipate and deal with.

You are indeed fortunate to live in an area where advanced medical care is readily at your fingertips but to hear your description, one would think that we here in the Deep South are using buckboard wagons and mule teams for ambulances and performing surgery on a door laid over two sawhorses. While I don't live in a bustling urban metropolis, I do have access to very fine medical care. My GI, for instance, is board certified and a Fellow of the American College of Gastroenterology. My colonoscopy was performed in a privately owned, freestanding endoscopy facility, just as yours was. I live near an excellent mid-sized medical center and I am within two hours' drive of not one, but two University affiliated teaching hospitals and transplant centers. Not many people are so well-located that they can claim to have two distinct facilities in two different states as their local transplant center, but I can, and do. It's amazing the resources you can find out here in the sticks!

Differences in experience and opinion are what make this forum so great. But, I have to say that I found what I perceived to be your rather condescending tone offensive. By the way, my procedure took place on June 29, and it went swimmingly, with versed/Demerol on board.

I am sorry, I didn't mean to appear condescending. I would never use the term "stump-dumb redneck". Actually my paternal great grand daddy and grandmother were from South Carolina. When I use the terms like "redneck", "hillbilly", "cotton picker", etc, I mean it as a term of endearment and it is said with a smile. I never figured you used buckboard wagons and mule teams as ambulances. I thought your ambulances were all modified versions of the General Lee. 😃

Actually what I meant by "we don't have to settle for doctors who took a course in colonoscopy in order to jump on the money train" was because we also see General Practitioners and General Surgeons who are now doing colonoscopies because they want to be on the money train. With an abundance of doctors comes and abundance of greed. More doctors means a larger pool of good, bad and mediocre.

You think I came off offensive. You did pretty good in your own right assuming what you experienced was what the entire US was experiencing. It appears your experience and conditions are different than those available in my area. I can accept that; but, it appears that insurance companies do not offer the same coverage in all parts of the US. Perhaps you may be right that throughout the US what you experience is more prevalent that what I am experiencing. I can assure you my GI doc isn't offering something that isn't covered. It is possible for individuals to agree to disagree without being disagreeable.

Now, can we please pass the Mason jar and toast General Robert E. Lee?

Suits me right down to the floor!

Well, since I am known here as the propofol queen of this forum and have lot to say on this topic both medically and personally speaking. So on Saturday when the good doc and I get some time together, we will go over some of these ponts with you.

I can tell you what I know at this point though. It used to be that propofol was a very expensive drug. Not sure when the price dropped but I know for the past few years anyway that it is basically dirt cheap and pretty comprable with the other mentioned medications.

FOr a normal colonoscopy, the doc would use maybe 20-30 ml's of propofol which is about 3 dollars worth. I believe you can get 5 20ml vials for just over ten bucks, at least according to the distributer web site last night.

But you guys are right in the fact that the price for using propofol isn't really with the drug itself, it's with the required personel needed to monitor the patient while using propofol.

Oddly enough, dispite all the BS in the news with Michael Jackson and the use of Propofol, propofol is NOT what killed him, and propofol is in fact a very very safe drug. It is very fast acting, quick in, quick out. Seldom does anyone have any sort of allergic reactions to it as many do with the others, and propofol doesn't cause that hang over,dizzyness, nauseated, time lossed types of feelings from the others.

Because of Michael Jackson and his idiot doctor, it brought propofol into a bad light, and has sense been watched by the government and us currently up for review to see if it needs stricter guidelines. Currently all propofol restrictions are regulated either by the state, or the facility.

For example, my doc has to have a scope done in the next year or so. He will have to travel about 50 miles away to the facility that uses propofol instead of versed. In his hospital, it's used, but not for colonoscopys.

Here in my state, nurses are not allowed to hang an initial bag of propofol, but we can maintain them and we can bolus with propofol at our descretion. We carry them around in our pockets all day long. It's not considered a narcotic and it is not counted.

So if you have a patent IV line and you are being a pain in my ass, and you see me coming at you with a 5cc syringe full of what looks like milk, you can pretty much figure on taking a little nap for a bit. Lol. I'm just kidding...

Seriously though, I just had my colonoscopy done a few days ago, three to be exact. I was very very spacific with them that I only wanted propofol and ketamine, nothing else. The doc agreed, and he only used propofol and ketamine. I woke up an hour later, as my scope took about 45 minutes, and I was alert and oriented, not nauseated, or "lost".

And that's my two cents worth at this point in time. He might have some more stuff to add this weekend if we have the time to ummmm, stop our activities long enough to take a quick break, lol.

I just had one done yesterday. It was my second one. This time they used a small dose of versed and Demerol. I was fading in and out and remember about half of it. I remember when he was done, he did a thorough DRE and I remember saying OW! Then I was put in recovery.

The worst part about the colonoscopy is the preparation the day before. What a bummer that is! Also, after the procedure, you will normally not produce a BM for several days! Since I have a Motor Neuron Disorder, the report showed that there were Increased Haustrations - Not exactly sure what that is, but I assume it has to do with muscle contractions in the sigmoid Colon probably related to the Neuromuscular issues I have. Any idea about INCREASED HAUSTRATIONS anyone?

Honestly, I had it done without sedation last year. Everything went very smooth and I was able to drive myself home afterwards. I really wouldn't consider doing it any other way. I hate the yuke feeling after receiving sedation drugs and I have to be honest, I kind of enjoyed the sensation of being vunerable and not knowing what to expect. I am a bit of a submissive at heart and I certainly felt the part lying on the examing table with my bottom fully exposed, feeling the pressure of the tube going in and coming out of me. Wow.

Doctor Proctor:

Here's the answer to haustration. I have to admit I had forgotten this one and had to go look it up. It means your colon isn't as wavy as it used to be.

haustrum

pl. haustra [L.] one of the pouches of the large intestine, produced by the puckering action of the tenia coli and responsible for circular muscle fibers at 0.5 to 1 inch distances, and responsible for the sacculated appearance of the large intestines of horses and pigs.

Saunders Comprehensive Veterinary Dictionary, 3 ed. © 2007 Elsevier, Inc. All rights reserved

Yeah, I know, it says horses and pigs. What can I say, I work in veterinary medicine. It applies to humans as well. We are not that different from the animals!

Ladydocisn said:

. . . . . It applies to humans as well. We are not that different from the animals!

Last I checked, we ARE animals.

[color=#ffffff].[/color]