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!

45 Responses to “Sedation-Free Colonoscopy: Why Isn’t It the Standard?”

  1. KR says:

    HELL NO! Would never even consider it! I would laugh at any GI who even suggested it.

  2. KR says:

    Furthermore, if I ever see this autjor’s name on a GI practice that I go to, I will be running far far away.

  3. Jack J says:

    Going without sedation is with a doubt the best way to have a colonoscopy. I had one this week. I did some research and read blogs from those who’ve done it and decided to try it. Well, it was a lot easier than I had imagined, an absolute breeze, hardly any discomfort at all. On a 1 to 10 pain scale I’d give it a 3. A few times I felt a cramp but it lasted about 2 seconds. Also, you get to watch the monitor to see how it looks in there, the Doc can talk to you explaining what’s going on, you can ask questions, he also might need a position shift for better maneuvering, something you can’t do when you’re out. It takes about 30 minutes. Afterwards, you lie around a bit, let the air escape from your butt, then hop in the car and go to lunch. I will never do sedation again.

  4. ML says:

    I had it without sedation at Kaiser Permanente Harbor City CA. Got to watch everything on big screen TV. Did not feel any pain what so ever. Only way I will do it on my next one 10 years later. No sedation. Quick in and out. Started at 8am and I was back at work at 11A.

  5. Alan says:

    I had my first colonoscopy done sedated in December 2010 and was uncomfortable about it. The Doctor was impatiently waiting for me to get under while he put on his grows and made the lubricant ready. One hour after the procedure I fainted and requested a trial basis non sedation colonoscopy. My Doctor is refusing the request and I don’t know what to do. I live in the Bronx of New York City.

  6. Mary says:

    I have a strong family history of colon cancer, so it’s obvious that frequent colonoscopies are a good idea for me…..I have had terrible reactions to “sedation” in the past from propofol, midazolam etc…minor stuff like respiratory distress, anaphalaxis, etc…..but when I try to explan that I need to schedule an unsedated colonoscopy, I have to argue with a nurse anesthetist who thinks that she’s an anesthesiologist, trying to convince me that I should risk sedation. sorry, I’m a physician and would never consent to procedural sedation, especially from a crna/nurse

  7. Paula T. says:

    ‘Had my third sedation-free colonoscopy yesterday, and for me it’s no big deal. There was a very brief pain (like sharp gas pang) at the splenic flexure, but other than that just pressure and bubbling, even when polyps were removed.

    Though I am not allergic to sedation or anesthesia, my few experiences with it have been very unpleasant, plus I’d rather avoid unnecessary chemicals.

    For the first procedure (eight years ago) the gastroenterologist and I discussed my preferences and were both comfortable planning for sedation-free. As a “just in case”, an IV line with fluids was put in with so sedation could be started quickly if needed.. That way offered best of both worlds and might be a good way to try one’s first sedation-free colonoscopy. ‘Certainly appreciate a doctor who cares enough to discuss options and do what’s best for each patient!

  8. Iatrogenia says:

    It’s important that the gastroenterologist has experience doing a non-sedated colonoscopy before and is gentle. Using CO2 and warm water to inflate the colon is supposed to be the least painful way to do it.

  9. Karla L says:

    I recently had my first colonoscopy. I waited until I was 56 because I did not want any sedation what so ever…and I didn’t know that this was an option. When a coworker told me she had a colonoscopy without sedation I immediately made an apppointment with her physician. I did my research and pretty much knew what to expect. I felt some sharp gas pain only once during the procedure but I knew this was normal and would only last a few seconds…which it did. At one point the scope coiled and the GI technician briefly palpated my stomach and this solved the problem. Because I knew this was not uncommon…I wasn’t too concerned. When the procedure was over I asked the physician “That was it”? I couldn’t believe how easy it was! There was never any time during the procedure that I wished I had been medicated. It really was not a big deal. Of course it helped that I found a physician that was willing to do this without sedation and in addition because she was a female she had more female patients than the male physicians in this particular clinic…so she had more experience doing this procedure on women. Women can be a bit more difficult to do because we are smaller and may have more twists and turns in our intestinal tract. After the procedure I was free to leave right away. I treated mself to a huge pastry at a nearby coffee shop and then went for a 4 mile walk. I felt perfectly fine after the procedure and I can honestly say I never experienced significant discomfort…just a few seconds of what felt like gas pain. There was no reason for me to be medicated.
    In addition, the prep wasn’t even that bad. My prep consisted of drinking a gallon of liquid laxative. I was given one packet of lemon flavoring for the entire gallon. Well…I had a feeling this would not quite do the trick so I purchased additional lemon flavoring packets and it made the prep much more palatable!
    I am so glad I discovered that it is possible to have this very important procedure done without sedation and have been telling others about my experience!

  10. CG says:

    I just want to say that I read this thread and live in the US and decided to try to do a sedation free colonoscopy and man did I ever regret it! First off I have a high tolerance for pain and I also only did a local anesthesia when getting my wisdom teeth out, but that is still numbing you. Let me just say my advice to any females getting a colposcopy done I would just take the medicine from the beginning. I thought I would be fine, so the nurse out the IV in anyways just to get saline going and then if I decided I couldn’t handle the pain the would add the conscious sedation. So they started and immediately there was immense pressure and discomfort. Then when the doctor got to a point where there was a loop or a turn the pain was 100% unbearable and I screamed and it felt like my stomach was going to pop open. Wow even thinking about this now is very scary to talk about. I made it about 80% of the way and could not go any further without the sedation. I was nervous about the effects if the sedation, but they are minimal to day the least I felt relaxed and best of all I wasn’t in pain. I hear that it is a little easier for men to have this done because they don’t have as many twists and turns, but my recommendation to any women out there is just to take the medicine. I know I would have been much happier had I done that. I now have a terrible memory of the pain and can’t get it out of my head. I’m so glad it’s over with!!!!! Hope this helps!

  11. Carol says:

    My experience was very much like Karla L’s. I just got back from my first colonoscopy ever; decided to NOT get sedated. That was the BEST decision I could have made! I could not believe how easily it went! There was very little discomfort. I felt bloaty and gassy from the air that was introduced, but it wasn’t constant and wasn’t more than mildly uncomfortable most of the time. “Moderately” uncomfortable at a couple of points may even be stating it too strongly. I’ve had menstrual cramps that were much more painful. My anus felt itrritated by the end–probably because it and the hemorrhoid next to it were already irritated by the bowel prep (which was annoying but not at all difficult or terrible)–but since the doctor was withdrawing the probe at that point, he said more lubricant wouldn’t really help. I was lucky–the office staff and nurses gave me no resistance at all when I asked not to be sedated; they noted it in my chart (I’d already written :no sedative” on my consent form) AND put a sign on my IV stand. I did have an IV line put in just as a precaution, and that was probably the worst part–I was a bit dehydrated and my veins were playing hide-and-seek, and the first attempt to put in a line was unsuccessful and a bit painful. But “Ouch” rather than “Aaarrrgghh!” My doctor was very gentle and took his time navigating the tricky turns. And I got to watch the monitor and ask questions–and remember it all. It was fascinating! Everyone was so impressed with my “bravery” and “stoicism” but I don’t get why; for me, at least, there was nothing to be “brave” about. It just was not a big deal. And now I have a whole free day ahead of me that I don’t need to spend sleeping off!.

    should note, however, that I was not presented with the option of no sedation–I had to ask for it. And if I hadn’t done my homework a few days ago (because the idea of being amnesic really bothered me a lot), I wouldn’t have known to ask and wouln’t have found this reassuring blog. My husband had a colonoscopy earlier this year at the same facility (different doctor) and had no idea he could refuse sedation. He has one brief memory of asking for more medication because it was painful, but can’t remember anything else until after he’d been at home and asleep for a few hours–een though we had a normal conversation on the drive home. I do wonder if, presented with the option of no sedation–which he would at least have given a try–he could have managed the pain better as a fully aware and engaged patient. I suspect so.

    • Howard says:

      Thanks Carol. Where do you live. General city. Just want to get an idea of where I would need to go to have this done at a facility that will do it without sedation.
      Thanks so much,

  12. Karla L says:

    Howard…I had my colonoscopy done in Seattle (The Polyclinic).
    Hope this helps!

  13. Jess says:

    At 24 I recently had a colonoscopy due to some concerning symptoms and family history. Due to past medical experiences I refused sedation. The doctor did not offer sedation free colonoscopy but went along with it once I told him I just could not handle being sedated. After reading on the internet I was rather certain that being a very small female I was probably going to have a lot of pain and would just have to grit my teeth and get through it. The most painful part of the procedure was actually the IV (for fluids)! There was one moment when the scope reached the very end where the discomfort turned into actual pain but no worse than the IV stick. There was a few minutes of significant discomfort as if I had eaten a unadvisedly large meal and had my nephew squeeze me. I didn’t even realize the scope had gone in until they were halfway through the colon. The doctor told me I did great and that he did unsedated colonoscopies all the time and most of his patients have no problems. I wish he had offered the option of unsedated colonoscopy up front and told me about all of his other unsedated scopes. Most people will probably still choose sedation but the numbers are inevitably biased toward sedation by the refusal of doctors to offer this option instead of waiting for a patient to ask.

  14. Ron says:

    I just had a colonoscopy and had 9 polyps removed. No pain medication, no sedation, NO PROBLEM!

  15. Colin says:

    First colonoscopy today. No sedation….Easy Peasy. A few cramps during, notihing more then 2/10 discomfort. Actually worse cramps when i got home wide awake and ate 3/4 of a pizza! Would never be sedated for this. Have had way worse dental cleanings.

  16. Harry says:

    I have been having distressing bleeding for a while possibly idicating colon cancer so my PCP strongly suggested a colonoscopy and I agreed. I scheduled the exam and got a letter in the mail indicating that an anesthesiologist would be doing the sedation. I have had terrible experienced in the past with sedation so I called to speak with the anesthesiologist and was told that I could only speak to an anesthetist (nurse) on the day of the procedure. I did the prep and arrived for the exam and was told that no anesthesiologist would do my case (in spite of the letter that I showed them) and an arrogant anesthetist nurse dismissed my previous sedation experiences and told me that she was doing my sedation. I politely refused sedation (it almost killed me in the past) and was told that the exam would not be done since an unsedated exam took a little longer. So I’m expected to accept risky sedation or not get a needed colonoscopy? What a joke. Sedation is unecessary and cost-driven.

  17. Cindy says:

    After reading all these blogs about colonoscopys without sedation…I was interested. The 1st one was 10 years ago. I had Versed 2 mg IV and my blood pressure dropped. (Plus I’m a hard IV stick.) So I was really interested in no sedation.
    I did the prep 32 oz Miralax day before and day of procedure but added some colace, bisacodyl and senna. I started in the morning so I could get to bed early and get up early to finish the prep. I was very clean.
    At the center, when the IV nurse came in…I told her I didn’t want an IV or sedation. She tried to be convincing. Finally she “asked” the doctor and he OKed the request.
    I am so glad I did it without sedation. But I think the doctor was hesitant. Some people have a curvey colon or sensitive mucosa making the procedure more painful.
    It was a bit awkward feeling the scope in the rectum for length of the procedure….It felt like I needed to squirt like I had been doing the entire previous day. There was some pressure and uncomfortable feeling during the procedure here and there. The nurses were instructed to “push” on my abd. I’m pretty sure my belly button meet my backbone. But it was okay. I kept my eyes on the screen which was fascinating for me. I had one polyp removed, that was interesting too. It was an interesting feeling as the extra fluid in the colon was removed by the scope, a rushing feeling.
    If they would have refused to do this without sedation, I would have walked out.
    I was able to ask questions and joke around during the procedure.
    My doc indicated that it was ALOT cheaper without sedation but not many people opt for this.
    This is the only way I will have this procedure again. I had some apple juice and graham crackers to put a few calories in me….then time to go.

  18. Steve says:

    I recently decided to have my colonoscopy without sedation, despite my doctor’s wishes. It took 15 minutes. On a scale of 1-10, the pain was a 3. And the pain occurred maybe 4 times, each lasting only 3-4 seconds. Half way though, I was wondering of I could grab my phone….maybe text someone or check my email.!!

    My doctor was very experienced, so I’m sure that helped. But to just get up and walk out, while the other patients that day lay drooling on the beds nearby, and staggering out with the nurses arm……plus the cost savings- no, not to me, but to the healthcare system. It felt great !

  19. jerry says:

    The patient should have the option of having an unsedated exam, Too often sedation is touted as a blissful, relaxing adjunct to an otherwise painful colonoscopy. This is false. Unsedated colonoscopy is safer (no problems with drugs and the unsedated patient will tell the doc when the scope forms a loop-avoiding perforation). Unsedated colonoscopy takes a little longer-hence the patient gets a better exam..but by taking a little extra time the exam is quite comfortable (I have had 3). Importantly, the sedation can cause many patients to experience significant side-effects; the common Versed/fentanyl combo frequently results in unpleasant amnesia for well beyond the exam..and most patients are not told that they are being given Versed to make them forget, not to “relax” them. Google Versed problems and see how many medical professionals would never receive this drug themselves. Give the patient a choice; if the want sedation just make sure that they are informed of the risks as well as the benefits..Remember, not everyone has someone to drive them home after a sedated exam. By insisting on sedation we rule out colonoscopy screening for this entire group.

  20. Shawn says:

    Karla L – what doc at which Polyclinic? Thanks!

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