anesthesia for colonoscopies-report

Thanks for posting the links. Gastroendo News is good. At c-scope last yr I had Propofol foisted on me, & was I mad! (I had always preferred to watch the scope monitor.) The only benefit I gleaned from it was that when I woke up in the recovery room, I could immediately think sequentially, rather than "drifting" after traditional Versed/Demerol combo sedative. (Versed & Demerol are actually frowned on now for senior citizen patients because they can exacerbate mental confusion.) My gastro is required to do c-scopes in the hospital's ambulatory procedure center, where a staff anesthesiologist reviews the patient's record before the scope & then an anesthesiology nurse administers the Propofol thru IV when gastro + equipment are ready to roll. Everything gets more complicated as we age, even if we don't manifest signs of severe illness. There are likely unreliable sites, though, where patients get anesthesia w/o adequate monitoring, and that's what results in negative statistics-- apart from incompetent endoscopists. / Old Hat (33 yrs with left-sided UC; presently in remission taking brandname Colazal)

I'm a bit bummed because I LOVE propofol, now I'll have to reconsider what to do for the next scope. My current GI does scopes at outpatient facility his group owns in their own building but also hospital nearby. I have my yearly office appt next week so will see what answers I get when he presses for a scope.

I have always had an anesthesiologist MD for scopes but never in-hospital.

Last week while getting skin cancer cut out (and insisting on maximum pain relief) that doctor said he would never have general anesthesia because of the high incidence of morbidity (I think that means death).

There's been some debate about whether a nurse (or a even a GI) should administer propofol at all. Many nurses would prefer that an anesthesiologist administer it. The dosage is tricky, and there is a fine line between enough and too much. Once too much has been administered, there is no reversal. Advanced measures must be taken to maintain an airway until the effects wear off. All these safeguards are limited at a basic outpatient center.

A lot of people think a puncture will be the end of the scope coming through the colon, like a needle through cloth. That's not the case. When the scope gets "stuck," it needs to be reduced (unkinked), and sometimes the pressure of the side of the scope puts too much pressure on the side of the colon, like a curve in a curve. Effectively and safely reducing the cope takes times.

At some outpatient centers, propofol is used to speed up the scope so that as many scopes as possible can be performed in a day. The more sedated a patient, the less feedback, and the more likely that reducing the scope will lead to a puncture.

The general population should seriously reconsider surveillance scopes after a certain age. Without any extra risk factors, sedation is more likely to cause death than colon cancer. There are safer methods of screening colon cancer and more on the way.

"There are safer methods of screening colon cancer and more on the way."

There is no evidence that the colonscopy is superior to sigmoidoscopy or even the occult blood test for normal cancer screenings. My mom, who is a retired nurse, was bullied by her last PCP to get a colonscopy even though she has no risk factors, had 2 clean scopes in the past and is 82. She switched to a new doctor who is is very respected and he follows the new USPSTF guidelines which recommend no colon cancer screening after age 75. The number of relatives and friends that have had serious problems after age 75 with sedation and anesthesia really scares her.

The American College of Gastroenterology found that GIs whose practice purchased a outpatient surgery center immediately began doing 20+% more colonscopies. Over testing and unnecessary expensive tests are the number one cause of high medical cost in the USA in my opinion. Years ago the sale of RX drugs(the other biggy) was seperate from MD practices. Not because doctors are crooks but because doctors are human and it creates a huge bias in prescribing meds.

I believe that most people with uncomplicated UC should have PCP that decides colonscopy frequency and when GI visits are needed. It is their job. Unfortunately, the US has a shortage because our system financially rewards becoming a specialist to excess and most PCP are referring everything which is in fact making their very important job obsolete.

Well, if you read *Jen*'s recent post on "stern talking" she mentions the issue of gastro bugging her to start having annual c-scopes, too. That is a GI who subspecializes in IBD treatment. But I hate their attitude that everyone has to do it annually-- because it's not a walk in the park, between the prep & manipulation we get subjected to at scope site when we're weary to the bone. Per Seconder's comment on keeping airway open, at my last c-scope the anesthesiology nurse was slapping an oxygen mask over my nose/mouth "in case of need" while I tried to remind the assisting staff that JELLY mattered as much-- or did they think that if patient gets totally knocked out the endoscopist can insert scope w/o it? Jeez!!!!! / Old Hat (33 yrs with left-sided UC; presently in remission taking brandname Colazal)