Am I put out for a colonoscopy or upper endoscopy?

I get this question a lot from my patients. 

Yes, you will be put to sleep (sedated) during colonoscopy or upper endoscopy in the US. There are some options for sedation. Outside the US, sedation remains an option in some areas. Ofcourse, I offer unsedated procedures for patients who prefer that way. One time patients go for unsedated procedure is when they cannot get a ride back home. However, not everyone would be able to tolerate an unsedated procedure. 

If you hear something like 'twilight sedation' or 'conscious sedation' for your colonoscopy, then you would be getting Fentanyl and Versed. Fentanyl is a medication for pain and Versed is a sedative. Benadryl could be added for aditional sedation benefit in some patients. Advantages to this sedation is that an anesthesiologist or nurse anesthetist need not be present and is administered by a registered nurse under the supervision of the doctor performing the procedure. Overall procedure cost is less. However, with this sedation, it takes a little longer to be put to sleep, may not be sedated completely (as there is a limit on the amount of medications that can used), takes a little longer to recover and most patients feel grogginess the whole day. 

The other option is Propofol (the 'Michael Jackson drug'). Propofol sedation during colonoscopy can result in a faster recovery and discharge, a shorter time to sedation and ambulation, as well as improved patient satisfaction. There are studies suggesting not increased rate of complications vs some others that suggest the opposite. In my experience, complications are more common in hospitalized patients with comorbidities. I like propofol for the quick onset and recovery and most patients report being almost normal for the rest of the day. Propofol is very popular with endoscopists in the US. However, it would also add additional cost for the procedure as it requires anesthesia assistance. 

With both options above, do not sign any legal documents or drive yourself as you would not be a 'normal' person for that day. All places would require you have a driver to take you back home and stay with you anywhere from 4 hours to 24 hours after sedation. This driver requirement is a hurdle for most patients as they cancel or do not show for their procedures due to not finding one. So, have a friend or relative ready! An uber ride/driver is not a substitute and would not be recommended as you would not be completely normal after sedation and you would be inviting trouble.

With both options above, after a full night rest you should be back to normal. 

#colonoscopy #endoscopy #sedation #sedationendoscopy #screeningcolonoscopy #propofol #versed #fentanyl

Author

Krishna Rayapudi MD DABOM Krishna Rayapudi MD DABOM is board certified in Gastroenterology and Obesity Medicine. Trained in world-class facilities with world-class mentors. Managed thousands of patients in all practice setups possible, with experience in seven different US states. You learn more about his practice at www.gastrooffice.com.