Awake During Colonoscopy--Again?

[athena53]

I also have not seen any research that indicates there is a higher risk of traumatic injuries during a colonoscopy with patients who are awake.

One point in favor of anaesthesia is that some people apparently have very "twisty" intestines that are difficult to navigate, which I guess you don't know till the first time you try it. I didn't have that problem. This discussion really has me convinced that I want to go back to the guy who worked without anaesthesia- but I'm not due for a couple more years.

 

[The Cosmic Avenger]

I had a completely drug free colonoscopy. The anesthesiologist sat in the corner reading a book the entire time! It was not painful at all, with just a minor amount of cramping. After the procedure, I hopped off the stretcher and walked home. No need for an escort. I carefully considered the risks of allergic reaction, respiratory problems, etc. from the sedation and decided that the risks or Propofol or Fentanyl outweigh any benefits. I also have not seen any research that indicates there is a higher risk of traumatic injuries during a colonoscopy with patients who are awake. (I have actually read studies that Propofol administration is associated with an increased risk of perforation). Most people in other countries, like Europe, do not use sedation. Yet in the U.S. doctors are now using full anesthesia for the procedure. It is very profitable. I have two friends who are gastroenterologists, and both had drug free colonoscopies. Something to consider...especially for those who are sensitive to anesthesia.

This is exactly what I was thinking. I have a colonoscopy scheduled without anesthesia, and my GI said that while he only has a few patients who do this, none of them have regretted it afterwards. Me, I prefer to let the dentist start drilling, and raise my hand and ask for novocaine if it starts to bother me too much. (I mean that literally, not figuratively. That's why I asked about and decided what I did about the colonoscopy.)

As for unanesthetized patients squirming around on the table...I can sit in a recliner all day without moving, I think I can lie still on a table for 2-3 hours!

 

[Lakewood90712]

We are talking "twilight Sleep" sedation, with Propofol ( aka Milk of Amnesia )right ?

Not heavy duty anesthesia - muscle paralyzer, breathing machine .

With the later, if I ever needed that , I would ask for an anesthesiologist who uses brain wave monitoring to be sure I am under throughout the surgery.

 

[Focus]

At the first colonoscopy, I was given a combo of Versed and Propofol. I felt terrible for a whole day afterward and swore never to do it again.

I insisted on no anesthesia for the next colonoscopy, and it went absolutely fine, despite some discomfort as they "rounded the corners." They told me they used the smaller tubing made for kids. One of the best things about it is that afterward you can hop off the table and head home immediately, without assistance.

 

[joel2125]

It is a sedation case so you may well have some recall. Relatively small price to pay for a potentially life saving procedure. But hey, I would worry about you if you liked it!

 

[sgstaley]

Cologuard "noninvasive" test

The noninvasive test (where you send in the fecal matter) is not really as complete a test as the colonoscopy. Most doctors will make you aware of that if you speak to them about it. The doctor will usually tell you that intestine cancer is the easiest to cure if you discover it early.

 

[sgstaley]

I guess I'm lucky when it comes to anesthesia, I'm always out like the proverbial lightbulb. Don't remember a thing, I wake up ready to get dressed and leave, it doesn't make me sick, and can we stop and get a pizza on the way home?

That is exactly what happened to me when I had my first colonoscopy. Comfortable, knocked out by drugs, colonoscopy, wake up, go home and eat. Done deal. I had literally no side effects. Frankly the only bad part was that bottle of meds that they make you drink to clean you out.

 

[mdtdej06]

No sedation for me either

I had a colonoscopy and requested no sedative. 4 nurses tried to talk me out of it. I declined it anyways. Procedure was not a problem. Definitely will do the same next time.

I had my first one 6 years ago and went without any sedation. I absolutely hate the nausea/yuckiness when coming out of sedation. A lot of the world never has sedation for colonoscopies and I understand why. There were only a couple of moments during the procedure that were painful and those lasted about 3 seconds each and kind of felt like bad brief intestinal gas pains.

The staff was surprised I would do it because I guess not many go without here in "otherwise everybody's tough as nails America" but after the experience I would never do it with sedation. A few seconds of discomfort compared to most of the day feeling yucky isn't even a contest.

 

[isisdave]

Get a doc who uses Propofol. Stuff works wonders.

That's what our center uses now. You're chatting away before the procedure, and next thing you know someone's saying "wake up" and you think you could go play ice hockey. And I never played ice hockey.

For my first one, they used versed and fentanyl, and the sleep experience during the procedure was the same, but then I slept the rest of the day.


The week before my recent colonoscopy, I had a cataract replacement. They used all three: versed, fentanyl, and propofol. It must have been a lot less of each, though, as there was no unconsciousness, no sleep later, and definitely no hockey.

 

[Doc0]

The insurance companies have been pushing for decades to eliminate anesthesia from colonoscopy because of the cost, except for severely ill patients like cardiac cripples, so if you get propofol consider yourself lucky. At some point it's likely insurance will simply stop paying and if you want anesthesia you will pay out of pocket.

 

[SojoMojo]

No Sedation needed

The last time I had a colonoscopy, I decided to do it without any sedation. I told the doctor that the last time I was given sedation, it screwed me up for a couple of days. When the word got out that I was going to have a colonoscopy without sedation, four nursing or medical students asked if they could watch. I said "Sure, the more the merrier!"



Without sedation, I watched the monitor as the colonoscopy was being performed and discussed with the doctor the polyps that he saw and removed. The doctor would warn me when he was going to make a turn with the scope since that's when the pain would occur. I think the doctor was much more careful since I was NOT sedated and if he perforated my colon, I'd know about it right away and raise HOLY HELL.



I'm scheduled for another colonoscopy next month. Like the last time, no sedation.



I didn't think the colonoscopy was so painful that sedation was warranted, but it all depends on your individual pain threshold.

 

[StaceyR]

Maybe CT Colonography is the answer...

I had the same unpleasant "Hey, I'm still awake!" experience almost 11 years ago and don't want a repeat performance so I'm thinking of trying CT Colonography instead. No anesthesia is required and its minimally "invasive" (inflation tube only). I'm still taking blood thinners for a recent stent so I like that the risk of perforation is practically zero. Unfortunately if they find polyps that require removal a colonoscopy is needed after all.

Has anyone here experienced a Virtual Colonoscopy (VC) aka CT Colonography (CTC)?

 

[athena53]

At some point it's likely insurance will simply stop paying and if you want anesthesia you will pay out of pocket.

I sure hope that nevers happens. Penny-wise and pound-foolish since my guess is that many more people will decide not to have a test that's not very enjoyable to begin with because they fear the pain and the "yuck factor" of being awake through it. The insurance companies will end up paying to treat more cases of colon cancer.

The noninvasive test (where you send in the fecal matter) is not really as complete a test as the colonoscopy. Most doctors will make you aware of that if you speak to them about it. The doctor will usually tell you that intestine cancer is the easiest to cure if you discover it early.

I just got one of those today- it's the fecal occult blood test, which is less specific, but it's been 3 years since the last colonoscopy and I'm due in 2 more years.

It was the at-home test that motivated me to get the real thing in 2005; I'd been convinced this was just another revenue-generator for the docs but when my gyno gave me the test kit and the results turned out positive I was concerned enough to get a colonoscopy. It turned up a nasty that could have turned cancerous by now. I'm a believer, And yes, I DID thank her!

 

[timo2]

The insurance companies have been pushing for decades to eliminate anesthesia from colonoscopy because of the cost, except for severely ill patients like cardiac cripples, so if you get propofol consider yourself lucky. At some point it's likely insurance will simply stop paying and if you want anesthesia you will pay out of pocket.

So we will go to the Three Stooges version: a big-arse wooden sledge hammer

 

[TromboneAl]

I'm going to ask for anesthesia for the prep phase.

 

[TromboneAl]

I've always wondered about the amnesia part of anesthetics. It's supposed to be important.

But does that mean that it's okay if it hurts like hell as long as you don't remember that? And if you feel no pain, who cares if you remember?

 

[NameTaken2]

An earlier post noted importance of early colon cancer diagnosis.
With 10yrs between colonoscopies common, seems like roulette-
10yrs is a long time between tests to develop colon cancer.
Apparently risk over 10yr, while depending on symptoms to detect early enough, is considered acceptable.

Anyone aware of basis for the extended 10 year timeline for low-risk people?

Just had a 10yr today, before saw this thread.
The experience and cost of this 'maintenance' = don't want next one sooner than 10yr (will be age 71), but this thread led to above Q.

Thanks for any perspective-
NT2

 

[gooddog]

Tell them you had a reaction to the Versed next time, and request Propofol. Fentanyl is just a really bad idea for a colonoscopy IMO...a bit like using a sledge hammer in place of a fly swatter. Have yet to meet a doc who has used Fentanyl for a typical colonoscopy.

 

[SDHiker]

There are genetic differences in how people metabolize the drugs given during these procedures. They should give you something else, because you are what they call a "fast metabolizer," and the drugs are wearing off too quickly. They should try drugs that are naturally longer lasting than fentanyl and midazolam (Versed). You should request a consultation with the anethesiologist next time. This should not happen, and doesn't in most people, but it can be addressed.

 

[Teacher Terry]

If they quit giving drugs people won’t do them. My mom had a sigmoidoscopy and no anesthesia and said it was incredibly painful.

 

[catii]

A few months ago, I had a colonoscopy AND EGD done at the same time - they met in the middle!


I prefer to be conscious, but felt no pain at all. No aftereffects, either. That's why I chose a doctor whose only business is performing those two procedures.

 

[Sanbenito1]

Never heard of anyone throwing up afterward, yuck. Perhaps you’re allergic to the drug? I’ve thrown up twice after drinking that nasty preparation juice- the prep was 10x worse than the actual procedure. Dad had colon cancer so I’ve been getting ‘extra care’ since I was 40, ugh. I’ve been awake through all of them and find it fascinating to watch and only slightly painful.

 

[michael274]

I actually am an anesthetist. The folks who are waking and remembering are likely folks getting fentanyl and versed by a nurse, supervised by the doc doing the scope. I would never be ok with this set up related to the doc needing to have all attention to finding any possible existing pathology (which is why you came). Most facilities offer anesthesia provided by a person who is qualified not only to give adequate anesthesia (painless while safe), but also having a person in the room who is trained in airway management. If you don’t think it’s important, ask Joan Rivers daughter. There were docs in the room, but no anesthesia personnel or adequate rescue equipment. The post earlier reported nausea is likely from narcotic. When I do scopes it’s lidocaine, then propofol (a profound antiemetic). The person who posted that she woke easily, then had lunch, likely had the anesthesia cocktail I use. Not having an airway specialist in the case is cheaper for the doc, but I’d never go for cheaper when it comes to my safety. GI doc’s are NOT airway specialists. Just saying...

 

[Boho]

I actually am an anesthetist. The folks who are waking and remembering are likely folks getting fentanyl and versed by a nurse, supervised by the doc doing the scope. I would never be ok with this set up related to the doc needing to have all attention to finding any possible existing pathology (which is why you came). Most facilities offer anesthesia provided by a person who is qualified not only to give adequate anesthesia (painless while safe), but also having a person in the room who is trained in airway management. If you don’t think it’s important, ask Joan Rivers daughter. There were docs in the room, but no anesthesia personnel or adequate rescue equipment. The post earlier reported nausea is likely from narcotic. When I do scopes it’s lidocaine, then propofol (a profound antiemetic). The person who posted that she woke easily, then had lunch, likely had the anesthesia cocktail I use. Not having an airway specialist in the case is cheaper for the doc, but I’d never go for cheaper when it comes to my safety. GI doc’s are NOT airway specialists. Just saying...

I've been reading about the use of ketamine when you don't want to surpress heart function or breathing. I'm particularly interested in its use during CPR, especially when a patient has been going through several episodes of inability to breathe, loss of consciousness, and CPR, possibly with broken ribs. When do you think ketamine is an appropriate anesthesia?

 

[TromboneAl]

An earlier post noted importance of early colon cancer diagnosis.
With 10yrs between colonoscopies common, seems like roulette-
10yrs is a long time between tests to develop colon cancer.
Apparently risk over 10yr, while depending on symptoms to detect early enough, is considered acceptable.

Anyone aware of basis for the extended 10 year timeline for low-risk people?

I've read that colon cancer is slow-growing.