Colonoscopy w/o sedative or anesthesia

RJM62

RJM62

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Geek on the Hill
Okay, so it's a bit off-topic...

Has anyone here undergone a colonoscopy without any sedative or anesthesia? I'm scheduled for a colonoscopy in August, and I'm leaning toward declining the propofol and whatever else they use, for various convenience-related reasons (don't need a driver or babysitter, no dopiness for the rest of the day, can get right back to work, etc.).

My impression is that getting the procedure without anesthesia is the norm everywhere except the United States, which makes me wonder whether it has more to do with the hospital's need for revenue than with the patient's need for sedation.

Thanks,

Rich
 
Making the scope do the two turns can be killer for pain. But if you can get by that, it's possible. Bu I mean really killer.
 
bbchien said:
Making the scope do the two turns can be killer for pain. But if you can get by that, it's possible. Bu I mean really killer.
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Thanks, doc.

The surgeon hasn't called me back yet, so I don't even know for sure if he'd be willing to do the procedure without the drugs. The hospital said it's up to the surgeon, but that I'd have to sign a waiver.

Thanks again,

-Rich
 
Way OT!

However, I have had doctors poke me with and without anesthesia.

In the no anesthesia case, I had made an appointment for a completely unrelated matter. Before I saw the doctor that had been recommended to me, his partner offered to screen me for whatever with a 'colonoscopy'. I agreed and found myself laying on my side. During the procedure, I asked whether this was standard procedure. He said no but that he was invovled in a study or something and was giving all office patients over 40, this exam, at no cost. "Oh, do you know I'm only 36?"

"hmm, No... this is going to be a bit uncomfortable when I go around the bend of your colon"

Was it painful? No. Uncomfortable? At turns, yes. The key point is that I don't think this was not what is normally given as a full colonoscopy. It was a shorter scope. It has a specific name that I don't recall but I'll call it the short form exam. The 'discomfort' beyond initial entry has to do with the mechanical interference between the hardward and the bend(s) in you colon. I think he only hit one on this particular exam.

Since then I've had 1 'standard' colonoscopy that is probably the type you are getting. Frankly the anesthesia is so effective that I don't remember a thing. But I think this is what I'll call a long form exam but I don't really know.

I wouldn't mind getting the short form without anesthesia... but the anesthesia would be a nice luxury. Assuming the second exam was different and deeper and possibly longer, I would definitely prefer some help. However, if I really just got the same thing both times, it's an unnecessary luxury and exposure to more drugs.

Hopefully some medical people can pipe in. Good Luck.
 
I would try first with a large suppository. If you feel the pain go with the anesthesia. This is a delicate procedure and you do not want to disturb the MD with your screaming

Good Luck

José
 
Piloto said:
I would try first with a large suppository. If you feel the pain go with the anesthesia. This is a delicate procedure and you do not want to disturb the MD with your screaming

Good Luck

José
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I remember the first time my puppy got a rear-end exam. I asked the vet if it hurt. His reply? "I don't feel a thing".

And he's still my vet thru many dogs.
 
RJM62 said:
Okay, so it's a bit off-topic...

Has anyone here undergone a colonoscopy without any sedative or anesthesia? I'm scheduled for a colonoscopy in August, and I'm leaning toward declining the propofol and whatever else they use, for various convenience-related reasons (don't need a driver or babysitter, no dopiness for the rest of the day, can get right back to work, etc.).

My impression is that getting the procedure without anesthesia is the norm everywhere except the United States, which makes me wonder whether it has more to do with the hospital's need for revenue than with the patient's need for sedation.

Thanks,

Rich
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Rich..here in Canada getting tranked is the norm for a colonoscopy...as a matter of fact the great buzz is the only good thing about the whole procedure.
 
Rich, You don't impress me as the type that would want to be awake for anal exploration. Take the meds!!!
 
Everskyward said:
I would think your squirming would disturb the MD more. They can always gag you. :D
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I told his nurse they can stuff a roll of gauze bandage in my mouth and tell me to shut up, if that helps any.

My last gall bladder attack lasted about six hours and was the worst pain I ever experienced. It was about twice as painful as I thought pain could ever be. I would have called 911 except that I was writhing on the floor in too much pain to get to the phone. I alternated between wishing that I could die and believing that my wish was about to be granted.

But I survived.

From what I'm reading here and elsewhere, most of the exam is merely uncomfortable, with the exception of the turns. Even if the pain at the turns is as severe as the gall bladder pain, we're only talking about, what, 10 or 20 seconds at each turn? Maybe 30 seconds at the most?

I think I'm inclined to deal with that pain for that duration in return for being able to just get back in my car, drive myself home, not need a babysitter for the rest of the day, and get back to work. But again, I'm not sure the doctor will be willing to do it, even if I am.

Thanks,

-Rich
 
Do the anesthesia, that way you won't remember the procedure. In residency I did flex sigmoidoscopies at the VA outpatient clinic. We went nowhere as far as colonoscopy and although the patients tolerated it I wouldn't personally go down that road without anesthesia.:no:

The good lord gave us the good meds so we could have things like colonoscopy done with no recollection of having them later.
 
RJM62 said:
I think I'm inclined to deal with that pain for that duration in return for being able to just get back in my car, drive myself home, not need a babysitter for the rest of the day, and get back to work. But again, I'm not sure the doctor will be willing to do it, even if I am.
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You do need a driver but you don't need a babysitter the rest of the day. At least they didn't tell me that. My driver dropped me off at my house and that was it.
 
Hell, I wouldn't mind an anesthetic for the annual poke 'n prod. If it isn't standard procedure elsewhere I'd worry about the folks elsewhere. Heck, lots of things I wouldn't do on a bad day are standard elsewhere.
 
genetk44 said:
Rich..here in Canada getting tranked is the norm for a colonoscopy...as a matter of fact the great buzz is the only good thing about the whole procedure.
Click to expand...

When I had to get an MRCP in Flushing, Queens years ago, the tech asked if I wanted to go outside and smoke some weed before the procedure, to help with the claustophobia.

I told the tech it wouldn't be necessary. I'd had MRIs before; and the scanner was roomier than some of the LSA I'd flown, anyway.

-Rich
 
I tend to fall asleep in MRI's and CAT scans. They usually end up tying my hands together so they don't fall to the table.
 
Jthamilton said:
Do the anesthesia, that way you won't remember the procedure. In residency I did flex sigmoidoscopies at the VA outpatient clinic. We went nowhere as far as colonoscopy and although the patients tolerated it I wouldn't personally go down that road without anesthesia.:no:

The good lord gave us the good meds so we could have things like colonoscopy done with no recollection of having them later.
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Thank you, doc.

I'm still waiting for the surgeon to call back, but the pre-admissions nurse just called and told me that the propofol dopiness is pretty short-lived. The warnings on the anesthesia consent form (that I agree to have a babysitter present for the next 24 hours, for example) are based on some longer-acting stuff they used to use. My procedure is scheduled for 8:00 a.m., and the nurse said I should be pretty much back to normal by noon.

I'm not a glutton for pain. I was just under the impression, based on the paperwork they gave me, that I was going to be tutto shangad until the next day. If it's just a matter of a few hours, that's different.

Thanks again,

-Rich
 
tmyers said:
I tend to fall asleep in MRI's and CAT scans. They usually end up tying my hands together so they don't fall to the table.
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Yeah, me too. They don't bother me in the least. Some people get freaked out by them, though, or so I'm told.

-Rich
 
Rich

Are you sure they will let you drive home? That would be very rare. Typically even without us the endoscopist will have one of his nurses give some sedation such as versed and demerol. If indeed you receive that sort of sedation it will last much much longer resulting in the grogginess you describe through the day. If you take the propofol, you will likely be unconscious through the procedure yet wide awake within about 20 minutes afterwards. Assuming you have a skilled endoscopist, you are clean, she/he doesn't find polyps to biopsy, etc it should only take 10 minutes or so. I have however seen these take well over an hour.
Is anesthesia necessary? Some insurance has said no it is not and has denied reimbursement. Some studies however have found increased polyp count in cases where anesthesia is used presumably due to better conditions for the endoscopist to work. Personally I would not have it without propofol but it is your choice. Whatever you choose, in a short while this will all be behind you!
 
Good luck, hope you have an uneventful procedure.

Once heard colleague of mine say that "celery is the colons toothbrush" Take it for what its worth and pony up to table on the fiber!:D
 
tmyers said:
I tend to fall asleep in MRI's and CAT scans. They usually end up tying my hands together so they don't fall to the table.
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People warned me about MRIs but I don't find them that bad. The last one they gave me earplugs and I could hear the tech talking but couldn't tell what she was saying...
 
The vast majority of endoscopists use versed and fentanyl... both are potent but short acting. And both are reversible in an emergency. Your sedation is likely not going to be administered by an anesthesia provider but by a registered nurse acting at the direction of the endoscopist. In the business, this practice is referred to as moderate sedation, or previously as conscious sedation. Properly administered, you are sleepy but able to follow directions.

Propofol is rarely used in a situation like this. Propofol as a general rule is not given to patients not being cared for by an anesthesia provider unless you are intubated and on a ventilator. Unless you are a rich popstar being treated for insomnia by an out of state cardiologist.

The sedation is two fold.. keeps you calm/makes you forget the study..... and it relaxes you to facilitate the exam.

I'd take the sedation and have a ride home..
 
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I had a screening colonoscopy a couple of years ago. The big PIA was the pre-procedure laxatives.

I got that Michael Jackson drug, it did make me dizzy for about two hours after the procedure and then I was fine. I don't remember the procedure at all. I think that drug was probably overkill, I bet something milder would have worked fine.

ETA: Last Tuesday I had a total knee replacement. They hit me with enough drugs to send Timothy O'Leary in to outer space. The colonoscopy was nothing by comparison.
 
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Hell, if you do propofol you're back up and out the door in 30 min . . . unless you have a doc hired by AEG. I surprised the doc by my level of consciousness - but for some reason these drugs don't take affect all that quickly so he had to give me a little more propofol - and then I slid right out.

My first one was 2mg IV lorazepam. that felt really good but I do have recollection of a little discomfort when they took the bends. The nurse after asked if I remembered anything and I told her that I recalled them going around the corners . . . she thought I would. Again - a drug that did not work at the level expected for the dosage given.

The tranks last alot longer than propofol . .. but after a couple hours you are pretty much back to civilization and normal thought with the ativan. . . .
 
FORANE said:
Rich

Are you sure they will let you drive home? That would be very rare. Typically even without us the endoscopist will have one of his nurses give some sedation such as versed and demerol. If indeed you receive that sort of sedation it will last much much longer resulting in the grogginess you describe through the day. If you take the propofol, you will likely be unconscious through the procedure yet wide awake within about 20 minutes afterwards. Assuming you have a skilled endoscopist, you are clean, she/he doesn't find polyps to biopsy, etc it should only take 10 minutes or so. I have however seen these take well over an hour.
Is anesthesia necessary? Some insurance has said no it is not and has denied reimbursement. Some studies however have found increased polyp count in cases where anesthesia is used presumably due to better conditions for the endoscopist to work. Personally I would not have it without propofol but it is your choice. Whatever you choose, in a short while this will all be behind you!
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Very nice pun! I hope it was intended. :rofl:

The hospital does allow the procedure to be done with no anesthetic or sedatives whatsoever, if the doctor agrees and the patient signs a waiver. In that case, the patient is allowed to drive home.

Thanks,

-Rich
 
You have friends here Rich . . . some guys are close and would help you out if no one wants to come pick you up! :D:D;):lol:
 
Doggtyred said:
The vast majority of endoscopists use versed and fentanyl... both are potent but short acting. And both are reversible in an emergency. Your sedation is likely not going to be administered by an anesthesia provider but by a registered nurse acting at the direction of the endoscopist. In the business, this practice is referred to as moderate sedation, or previously as conscious sedation. Properly administered, you are sleepy but able to follow directions.

Propofol is rarely used in a situation like this. Propofol as a general rule is not given to patients not being cared for by an anesthesia provider unless you are intubated and on a ventilator. Unless you are a rich popstar being treated for insomnia by an out of state cardiologist.

The sedation is two fold.. keeps you calm/makes you forget the study..... and it relaxes you to facilitate the exam.

I'd take the sedation and have a ride home..
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They specifically told me they would be using propofol, which seems to be their standard procedure. That's on one of the consent forms. The other form doesn't mention any particular anesthesia, and is basically just a set of promises that I won't work, drive, make any important decisions, sign any contracts, leave my babysitter's side, embark on an interstellar space voyage, etc., for 24 hours.

The more I read about propofol, however, the less I think I have anything to worry about. The second form is the one that had me thinking I'd rather deal with the pain than be a zombie until the next day, plus have to have a friend or relative take the whole day off to sit by my side. Apparently, that's not the case.

Thanks,

-Rich
 
I had the procedure earlier this month with propofol only. The anesthesiologist was willing to do it without any drugs at all, but since propofol is short acting I opted for the slumber drug. It seems to be very short acting in fact, I had a touch of double vision as I came out of it but that was gone in a minute or two, and I was wide awake in 10 minutes at the most. (Still, I wouldn't drive or fly a plane for at least 24 hours afterward.)

If you really want it done without benefit of chemistry, just talk to them and see what they're willing to do.
 
comanchepilot said:
You have friends here Rich . . . some guys are close and would help you out if no one wants to come pick you up! :D:D;):lol:
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Thanks, Joe.

Actually, I've had several friends and family members offer to pick me up. I just felt bad imposing on them when I thought I'd be a drooling invalid for 24 hours.

I suppose if I do take the propofol (which is seeming more likely, based on what people here and elsewhere have said about it), I'll just have my dad drive me there and pick me up. He's getting on in years -- obviously -- and he does like to still feel useful. As long as we're not talking about his having to wipe drool from my chin, this would be a good opportunity to give him that opportunity.

-Rich
 
RJM62 said:
The more I read about propofol, however, the less I think I have anything to worry about. The second form is the one that had me thinking I'd rather deal with the pain than be a zombie until the next day, plus have to have a friend or relative take the whole day off to sit by my side. Apparently, that's not the case.
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I had the procedure back in May. Fifteen minutes after waking up I was clear headed and went to lunch with a friend. Lesson learned, take lunch out of doors, preferably with some loud background noise or music and maybe a breeze blowing.

I was fine the rest of the day. No adult supervision required. Propofol is benign to say the least in terms of a properly administered drug.
 
Rich, the good news is you are having the procedure done. It saves a tremendous amount of pain and suffering when you avoid cancer!

I had it done 8 years ago. No big deal at all, but I would not advise no drugs. :no:

My wife has to have it done every 3 years due to family history. She is a loonie tune coming down off the drugs. Can't remember 5 mins back. Everyone handles it different, listen to the DR. I would not recommend you not having someone around for a while. It would be self defeating to go in for cancer screening and then go home and kill yourself by burning the house down. ;)
 
Geico266 said:
Rich, the good news is you are having the procedure done. It saves a tremendous amount of pain and suffering when you avoid cancer!

I had it done 8 years ago. No big deal at all, but I would not advise no drugs. :no:

My wife has to have it done every 3 years due to family history. She is a loonie tune coming down off the drugs. Can't remember 5 mins back. Everyone handles it different, listen to the DR. I would not recommend you not having someone around for a while. It would be self defeating to go in for cancer screening and then go home and kill yourself by burning the house down. ;)
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Thanks. Like I said, I'm now leaning toward accepting the anesthesia, now that I know it's less likely to make a zombie of me. Big waste of a thread, I guess; but hey, at least it provided the opportunity for the exchange of both information and a bit of humor.

-Rich
 
Well, the doc called me back. He told me he was willing to do the procedure with or without anesthesia, and had done two without any anesthesia or sedation whatsoever this past week. But he wondered why I'd want to do it without sedation seeing as how BC/BS will cover it either way.

I explained that I'd just like to be OOC for as short a time as possible, and he told me that I should basically be okay for pretty much anything except driving or flying within an hour or two after the procedure, and the other two by the next morning.

He left the decision to me, however, so I told him to just go ahead and put me under. As long as I'm not going to be any more of a babbling, drooling idiot than usual, that's fine. I get enough adventure in my life without feeling all the details of this particular experience.

Thanks for all the replies.

-Rich
 
Can't remember what they gave me. My wife gave me a ride home and we stopped for a sandwich along the way. About every half hour for most of the afternoon I kept asking her if we had stopped for lunch. By evening my head was clear and I was back to what's normal for me.
 
Matthew said:
Can't remember what they gave me.
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Good thing, too :) :) :)
My wife gave me a ride home and we stopped for a sandwich along the way. About every half hour for most of the afternoon I kept asking her if we had stopped for lunch. By evening my head was clear and I was back to what's normal for me.
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That's about right.
 
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