February 18th, 2009
Sedation-Free Colonoscopy: Why Isn’t It the Standard?
This Saturday’s Wall Street Journal featured an intriguing article on sedation-free colonoscopy, which is standard in Europe and Asia but rarely done in the U.S. One could argue that Americans are just “weenies,” but I think the blame rests solely with us doctors.
Sedation-free colonoscopy is successful in most who try it (I did!), but it does require a more careful exam to ensure that patients are comfortable. Over-distension, looping, and other problems that can cause pain must be avoided, and that means the doctor must spend more time and perform more maneuvers during each procedure. And therein lies the rub. Even though sedation-free colonoscopy is safer and cheaper for patients, most gastroenterologists already feel rushed when they see patients and don’t want to take the time to even broach the subject of sedation-free colonoscopy, let alone actually perform it.
What’s my recommendation? Discuss the availability and benefits of sedation-free colonoscopy with all your patients, and let’s let Americans know to ask for it. It’s a better way to get the exam — and you can even drive yourself home that day!
Great article. Sedation should be offered to colonoscopy patients but they should not be told that unsedated colonoscopy is difficult-it’s safe and pretty comfortable; I had several unsedated colonoscopies (I am allergic to the drugs)overseas and they were easy. The USAF recently returned me to the USA (Yeah!) and I met with a new gastro and she insisted (correctly) that since I had the FAP gene that I needed to have her to my colonoscopy immediately since I was high-risk and overdue. I totally agree and mention that I don’t want sedation since it almost killed me. I report for the colonoscopy and am immediatedly confronted by a crna telling me that I have to have sedation for a colonoscopy (this is false and I”m surprized that as a nurse that she doesn’t know better)..I give her my records documenting severe sedation reactions..which she seems to ignore and insists that I sign a sedation consent which I obviously refuse. Great medical care: agree to unecessary colonoscopy sedation or be refused to have an essential exam. Nice. As I was getting dressed my wife asked the CRNA if she knew what my having the FAP gene meant (high risk of colon cancer without frequent colonoscopies) and she was told: “we don’t want to do unsedated colonoscopies because they take a little longer and we have a busy schedule”
Have not found anyplace in CT/MA that performs unsedated colonoscopies. Most require versed/demerol or propofol. I think the versed/demerol combo is most likely safer than propofol, and can also be titrated down to allow for the smallest dosage with more given as needed.
I am astounded that docs generally have ONE protocol and the patient dutifully has to accept or go elsewhere.
Curious if anyone knows of a good GI doctor who does offer options ( and unsedated colonoscopies) in CT or MA. Also, would younger vs older doctors make any difference?
Greetings and Thank You All for your posts.
Long story so I won’t go into it now, but I am so glad I found this and have the ammunition I need to “Demand” a sedation free colonoscopy. I will update.