“TELL ME MORE ABOUT THE SEDATION….”
To answer today’s question, I turn the blog over to my colleague, Dr. Kelly McCullough:
Dr. McCullough was born and raised in Seattle, Washington. He attended the University of Washington School of Medicine, stayed at the University of Washington for Internal Medicine residency, and completed his training with a three year Gastroenterology fellowship also at the University of Washington. He is board certified in Internal Medicine and Gastroenterology. Dr. McCullough joined Northwest Gastroenterology in 2005. He is married and has two amazing children.
Unlike major surgery where patients may receive a “general anesthetic”, colonoscopy is generally performed with patients receiving moderate conscious sedation.
Versed and fentanyl are given together at doses which make a patient feel quite sleepy and comfortable, but able to respond to questions.
Versed is a sedative related to valium. Fentanyl is a narcotic related to morphine.
These medications are fairly quick to act and quick to wear off, allowing sedation during the procedure and steady post-procedure recovery.
These medications are given repeatedly through a procedure to maintain patient comfort. Both medications have antidotes or reversal agents, which can be used to reverse sedation if needed.
During colonoscopy, air is used to inflate the colon, allowing inspection. That air can feel like gas, and at times, gas pains. Sedation helps block these gas pains.
Maintaining patient comfort is essential to quality colonoscopy, as it allows us time to thoroughly inspect the colon lining.
During the first portion of the exam, the colonoscope is advanced to the cecum, or beginning of the colon, the area of attachment to the small intestine. This is the time sedation is most helpful in preventing pain.
As the colonoscope is withdrawn, or pulled back toward the rectum, the exam becomes less and less stimulating (less uncomfortable) so sedation is allowed to begin wearing off.
Often patients may be somewhat awake for the last few minutes of the exam and are often quite curious. “Is that me?” is not an uncommon question. “Yes” is the answer.
Can colonoscopy be done without sedation?
Yes, colonoscopy can be done without sedation but it can hurt. People with any abdominal pain should not consider unsedated colonoscopy- it tends to be pretty miserable. It is generally hard to predict how patients will tolerate an exam without sedation.
During colonoscopy, the goal is to be very thorough. If a patient is uncomfortable and asking “how much longer”, this is not ideal and risks compromising the exam. You don’t want to ask your doctor to hurry.
Will I remember anything? Will I be totally out?
The goal is for patients to be comfortable - without pain, anxiety, or stress. Sedation is given during colonoscopy to maintain comfort. The sedative, Versed, may limit memory of the procedure - in fact, at the end of a colonoscopy some patients ask when we are going to begin.
There are times when deeper or more profound sedation is appropriate - these circumstances are generally identified and discussed during a pre-operative appointment.
