Colonoscopies are routinely performed without sedation in Europe and Asia.
With health care costs rising, and staffing become scarce, a study suggests that a no-sedation colonoscopy can help on both fronts. Of 145 patients who elected to undergo a colonoscopy without sedation, 112 completed the procedure.
As a gastroenterologist shortage is looming, a no-sedation colonoscopy may become an option for some patients.
Additionally, patients do not need rides to and from the hospital, as required by those undergoing sedation, and the risk of a bowel perforation is dramatically reduced.
Related posts:
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- Virtual colonoscopy
- Questions to ask before your colonoscopy
- Virtual colonoscopy
- Colon cancer screening guidelines
- A free colonoscopy contest, but what’s the catch?
- Colonoscopy by primary care doctors, is it time to start joining the proceduralists?
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{ 24 comments }
There will be no shortage of endoscopists because we don’t need gastroenterologists for colonoscopies. More importantly, even if there were an endoscopist shortage, that has no relation to whether or not patients are sedated for the procedure.
Personally, I would prefer the sedation. However, I think you make a good point. If we continue on this route, however, what other types of procedures will be submitted to the no-sedation column?
Had one while I was at work, walked along the corridor, had procedure, walked back and continued with my day. No problem.
oh god. NO NO NO NO NO. Not if you paid me. I’d pay out of pocket or forego it entirely before I’d do a thing like that.
I never had one without sedation, so I wouldn’t know how painful it is, but I would at least try it.
I’m always curious to see the screen! I suspect it could also be useful to communicate to the doctor and feedback if it’s different from last time…
I am a physician and attempted my first colonoscopy without anaesthesia – initially things went OK by ultimately required conscious sedation to complete the procedure. Next time I will probably opt for sedation from the beginning.
I’m a med student and I needed to have my UGI scoped while I was on the surgical service. I couldn’t get an appointment when I was post-call, my chief wouldn’t give me a day off and in the end, all I could get was an appointment in the afternoon of a day I was on call at an off campus endoscopy suite.
I walked in, asked for no sedation, they made me take a baby dose (I think more so the nurses would stop freaking out over my request). It was fine in the end: I just swallowed the camara, they looked around and pulled the camara out. I was groggy for maybe an 30 minutes took the train back to hospital, signed my pager back in and took sign out.
Maybe the lower is a lot more painful, but the attending who did my upper said he had gotten an upper without any sedation when he was in Asia and it was no problem.
I had one without and it was one of the most painful thing I’ve ever experienced. It felt like my abdomen was going to explode. Just when I thought the pain couldn’t get worse, it did. Never again.
I had my first colonoscopy yesterday morning WITHOUT SEDATION, at my request. If you are determined to do it that way, it can be done. It was somewhat uncomfortable but not really painful and certainly bearable. It just felt like cramps at some points.
I had a great DR. with 27 years experience and he was willing to work with me so that I could start the procedure without sedation and he would give it to me only if I requested it or was in too much pain. That never happened. I made it through quite easily and resumed my daily activities shortly after.
My suggestion to anyone leery of sedation is to find a Dr. that will listen you and work with you as a patient instead of doing only what he/she thinks is right. Find one that knows how to do it without sedation. After all, it’s your body!
You’re going to have to buy me a drink first.
)))
As someone who has had several colonoscopies WITHOUT sedation, let me state categorically, I DO NOT recommend it. It is painful. My gastro and I found out several years ago that I can tolerate it. However, realizing the whole room sees your posterior and the the fact that the prep does not clean 100%, most people would not prefer it. I’ve had people ask me if I thought they could do it, and I always no. Let me state again, when the scope moves over the middle section IT HURTS!
The advantages of unsedated colonoscopy are mainfold: perforation is virtually impossible, no risk from sedation, no need for a drive home and decreased time and cost. I work in a hospital and have seen numerous colonoscopies; too often the patient writhes in pain because the endoscopist is rough and does the exam too quickly, relying on “procedural amnesia” to prevent the patient from complaining immediately after the procedure. Then the poor patient goes home and often has flashbacks of a rushed, painful procedure and is haunted by nightmares. I found a wonderful woman Gi doc who listened to me and did mine unsedated; by taking some extra time I got a better, much safer exam without the often haunting “Versed creepy amnesia”. Embarassing? She asked me “would you be embarassed to expel the air that I pump into your colon in front of me and the endo nurses during the test”? I said no, of course not, she laughed and told me not to worry, expect some brief cramps but probably nothing bad. And you feel this anyway with sedation; you may or may not have temporary amnesia from Versed and you may have a bad sedation experience. She did make me promise to let her have a syringe full of fentanyl hooked up in the IV line, just in case it was too painful and she said that I had to let her use her judgement on using it. The exam was easy and I didn’t need the fentanly. I had some pain from trapped air which I couldn’t get rid of and when one of the nurses told the doc that my wife was my driver in the waiting room she told me it was time for the fentanly to get rid of the painful trapped air, so she have it at the end. No sedation issues, didn’t really feel anything for about 5 minutes then she put her hand on my shoulder and told me to “relax and close your eyes”. I remember farting loudly (to applause) as I had a brief nap. That was an easy test.
I’m a hospital pharmacist and I always thought that sedation was pretty benign; after all, most patients don’t remember anything immediately after the procedure, right? Problem is, after a few hours, days or weeks, the procedural amnesia wears off and many, many patients are haunted by “creepy Versed amnesia” or PTSD reactions and or memory loss. The GI people say this isn’t so; of course, they only see the patients immediately post-procedure; I interview them days, weeks and months later. Problems with sedation, particularly Versed are HUGE. Check out askapatient.com for Versed horror stories. They are many.
I’m surprised to see that the majority of “NO NO NO NOT EVER” whiny complaints are from those who have never had one without sedation. Of the 3 comments posted from those who had theirs without sedation, 2 did well and one said it was painful. Well, now I make 4 people posted on here who did not have sedation (not a drop of meds at all) and 1 who definitely had NO PROBLEM. For more information from some real research on this, see: http://www.springerlink.com/content/h75r219105l837t1/ and http://www.ama-assn.org/amednews/2009/01/12/hll20112.htm
Was there pain for me? None. Was there discomfort for me? Some. Mostly it was a sense of pressure, like a small balloon moving through you. Most of the pressure was at the turns (there are 4 of them along the path) and that pressure was very short. They even did 4 biopsy cuts into the colon wall and I felt the slight pressure of the tool, but no pain at all.
It was definitely worth it to watch the process on the monitor and not only listen to the running commentary and explanation of the doctor but also to interact with him during the procedure. I was able to ask questions about what we were seeing and he gladly answered and explained.
Now to be fully honest, when they removed the heart monitor tabs taped to my chest long after the colonoscope was removed, that was painful. Those things pulled the hair out of my chest and that was the only painful part! To be more honest still, no sedation is probably not for everyone. The squeamish about someone sticking something up their butt and passing gas in front of a doctor, a nurse and an anesthesiologist should probably take the sedation just to avoid being embarrassed.
I will do all future colonoscopies without sedation. I could drive immediately after and went back to work, so I didn’t lose a day to the groggies. This was my 2nd colonoscopy. For the first one a few years ago, I told the doctor I wanted the “minimum sedation required for him to perform the procedure.” While he asked, “Why is that?” he shot me full of stuff. After that, the nurse said, “Honestly, honey, you don’t need any sedation for us to perform the procedure.” Thanks for your honestly too late! I felt ignored and disrespected. All he wanted was a pliable piece of meat on the table to do his job and get paid. (end of rant, back to topic.) I was out for the entirety of the procedure and woke up with a juice bottle in one hand and a nutrition bar in the other. While eating, back down again. Next, up and putting my clothes back on, then down again. Later, up again in the car back home, then down again. Later still, up again at the dinner table eating, and I made it to the end of the meal, but then back down again when I hit the sofa. Didn’t wake up completely until about 11 PM and my procedure was done at 10 AM. 13 hours of groggies to avoid 30 minutes of discomfort (NO PAIN, remember?)! I’ll take discomfort.
The main key is your relationship with the doctor: be clear with the doctor when you make the appointment that you want to try it without sedation, but are willing to have the IV line in and sedation ready (and consent forms signed) in case you decide you want it or in case s/he decides you need it. If a doctor is unreasonable with this level of reasonableness on your part, find another doctor. Remember: doctors are not doing us some grand favor by squeezing us into their tight schedules; rather, we are hiring them to perform a service and we can fire them (which I did to doctor #1, good for him that I didn’t sue him for improperly addressing my request, at least the nurse was honest) or shop around just as we do for other things. So find one that will work with you. Just be reasonable.
And to the whiney nay-sayers, please keep quiet unless you have real evidence to back up your fear-mongering. And to the one who had pain with it, I’m sorry it worked out poorly for you. But at least you didn’t have the groggies for 12 hours on top of it.
I have the misfortune of needing yearly colonoscopies and I do NOT like conscious sedation. My wife is a CRNA and when she explained that colonoscopy sedation is primarily given so that the endoscopist has an imobile, amnesic patient, not for patient comfort or safety (colonoscopy is more dangerous with sedation; if you are sedated you can’t feel the scope getting looped and that’s how perforations happen)..I could not believe the arrogance and deceit among endoscopist involving colonoscopy sedation; they “insist” on it so they can do the procedures more quickly ($$) and a lot of them don’t care about the patient. Once you are out the door, they could care less about grogginess, a missed days work or long-term amnesia. I arranged for a sedation-free exam and the gastro lied; he assured me that the exam would be sedation free, but before we started, he tried to inject Versed into my IV. I almost broke his wrist. If you want sedation, fine. It’s unecessary, but providers should not lie to patients. I have had 4 with nothing and they were a breeze; probably because the endo doc was gentle and honest; she said that sedation-free colonoscopy is the standard world-wide; in the US it’s a “secret” option…..
I’m a CRNA and a significant component of my salary comes from providing endoscopy sedation (propofol for colonoscopies, usually). If you want sedation, get an anesthesia person to administer it. Anesthesia providers use propofol for deeper sedation without the problems associated with midazolam (Versed) that is usually given by endo clinics. I have heard hundreds of sedation horror stories from patients who have undergone colonoscopy sedation with Versed; about 10% have a terrible experience during the procedure and many go home to develop PTSD as the wonderful Versed amnesia wears off. I hate to say it but the reason that colonoscopy sedaionis so common is: money. They want to do the procedure quickly, giving the patient a large dose of an amnesic like Versedmakes this easy..it also makes colooscopy WAY more dangerous for the patient. Find a decent endo who will do your exam unsedated…..you probably don’t need it anyway. And nobody needs Versed……….
I’m a PA student and have had a colonoscopy (as far as the hepatic flexure at least) without any sedation. I can report that this was quite possibly the most pain/uncomfortable experience of my life. I accept that my experience may be isolated and is most certainly multifactorial (skill of the endoscopist, etc) but I will never attempt the procedure again without some type of sedation. I do agree, despite the pain, that it was fantastic to be able to walk out on my own and drive home after the procedure without any type of sedation hangover.
I have a vested interest in colonoscopy because I have to get them quite often; being married to a gastroenterologist has given me some insight into how they are done. Sedation is fine if you want it, but it’s not necessary and certianly not risk-free. The typical versed/fentanyl combo given by most endo centers is usually well-tolerated, but about 10% of the patients report a horrendous experience and often experience long-term memory/psychic trauma from the versed. Not everyone wants amnesia and it can be long-lasting, and this comes from versed/fentanyl being administered by non-anesthesia personnel (endo nurses). MAC (propofol) given by anesthesia providers is bette tolerated, but all sedation increases the risk of perforation becasue the patient can’t respond to pain. I have had all of mine unsedated and they were easy. Why do some people have so much trouble (sedated or not) with colonscopy? My wife says that a lot of GI docs are rushing the exam needlessly for profit motives. Her practice stopped using versed/fentanyl and uses propofol for sedation; except for people like me who refuse sedation (and like most of the office staff who also refuse sedation)… Get the picture? Insiders get a slow, careful, unsedated exam…..Read: unsedated=better, safer, comfortable and without the many disadvantages of sedation. But still, unsedated exams are a “secret” option that you have to ask for and insist upon.
I am a R.N. who understands all the mechanics of colonoscopies. Since I have IBD,I have had many. All with sedation(sometimes with Versedk,but more recently with propofol). I have a low pain tolerance,and some anxiety. I think to label patients as “wimps or whiners” if they take sedation is unfair,and does not take into account that each
and every pt. is different,and therefore has different needs. I agree Gastroenterologists should offer a no sedation option,but should also be willing and have staff capable of
providing appropiate sedation for any GI procedure.
I have a comment: I’m 54 and recently had a colonoscopy that probably saved my life. I knew that I needed to have this done at 40, but after seeing the terrible time that several of my friends went thru with the procedural sedation (amnesia, memory loss, almost frank psychosis), I decided to take my chances and skip the exam. Bad decision, by the time I had symptoms, it was almost too late. Luckily I found a good endo doc who said that the unsedated exam was no big deal; they usually do sedation because most people want it……God help you if you are in the 10% who have a bad reaction to the sedation…anyway, the exam was pretty easy; she found a pre-cancerous condition and I had surgery. Now I get yearly exams; I’m lucky enough to have ofund a doctor who is willing to take a little extra time to do the unsedated exam……
One thing that gastro doc’s often blur is the distinction between sedation and analgesia. I don’t want memory-loss and the trauma of versed-induced sedation (it’s scary and more common than you think), but I don’t want a painful exam. My doc then told me that if I wanted painkiller (fentanyl) only and no amnesia drug (versed), that was possible. Why isn’t the “painkiller only”option offered? A nurse told me it was because “we like to work with an amnesic patient”. I asked her if she would want versed herself and she said ‘no”…so they want YOU to have amnesia drugs but won;t take them..
Given the way that most gastro docs use sedation just so they can do colonoscopies more quickly and not for patient benefit, I will skip the sedation and probably skip the exam. I’m an advance-practice RN and the current state of how conscious sedation is practiced is really depressing.
Sedation for colonoscopy is overused; I got so freaked out by reading the versed horror stories (most are true) that I kept putting this exam off until the symptoms got bad…not a good idea. Not one GI doc that I called would do an unsedated exam (they all said that “it slowed them down too much”)…One day at work (at a University Hospital), one of the GI docs overheard my colonoscopy sedation rant as I was talking to a nurse; the GI doc wrote me a rx for the prep and told me to show up the next day at 0730 and she wold do the colonoscopy unsedated. Yipee! She also called me that evening and reassured me that the exam would be no big deal; she would take her time and talk me through it. The exam was breeze; had a precancerous condition and I will be getting yearly exams for a while. No sedation, no missing work, no memory loss! If you find a doc who will take his/her time, colonoscopy sedation is strictly optional.
I forgot the best part: my doc said that she has done thousands of colonoscopies and she has NEVER heard of a patient getting perforated unless they were sedated. Without sedation, the exam is almost totally risk free; one of the GI docs on her service would scope himself (no kidding) to demonstrate the exam for residents..he had IBS and needed to get them anyway,, unsedated colonoscopy is obviously very safe.
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