General Anesthesia for Colonoscopy?

[Jack54]

I have had 2 colonoscopies in the past done by two different doctors. Conscious sedation was used for the first without any problems at all.

The second I had done 3 years ago, I lost consciousness during the attempt to consciously sedate me. They were using valium and versed, which I am really accustomed to, due to having had eleven cardiac catheterizations. No problems with allergic reactions to these drugs ever. The doctor said it was due to dehydration! Wow, I figure most who go in for a colonoscopy are dehydrated to some degree due to the "night before" ordeal and no water the next morning.

Due to the removal of polyps on my last colonoscopy, I am scheduled to have another the 28th of this month. I am using the same doctor where I passed out before the procedure began. He is going to have me placed under general anesthesia for the procedure, due to my having lost consciousness 3 years ago. I agreed, or shall I say that I had nothing to say at the time he was arranging this.

Now, I am thinking about the last time I went under general anesthesia for sinus surgery, about 2 years ago. I had a very hard time in starting to breathe on my own. I guess because I kept falling back to sleep and would not breathe.

The nurse in recovery kept having to wake me and say "breathe". When I was taken back to my room, the same thing kept happening for ~30-45 minutes. I think I would have died, had it not been for my wife waking me up and telling me to breathe. It was outpatient surgery and I wasn't being monitored.

My question is should I cancel this procedure with this doctor and go back to the first doctor, where I had no problems with conscious sedation? He performed this procedure around 7 years ago, before my heart attack. Yet I was taking a beta blocker for BP control at the time.

Should I expect to have a colonoscopy done using only conscious sedation, or is it more safe to go with general anesthesia, and should I?

Thanks very much,

Jack

[lizziecee]

Hi there - well I still live and learn!  Thanks for your information on "conscious sedation".
I have never been "awake" when having twilight sedation, but my sister had a colonoscopy a few years back and she said she was conscious and saw everything that happened. Perhaps my gastro gives me enough medication to "knock me out", which is what I prefer. I have just recently had a gastroscopy for oesophagitis, and looking at the Endoscopy report, it shows that the meds they used for this procedure were:
Fentanyl 50 mcg and Midazolam 2 mg.  Duck soup....I came round gently in the recovery room.

Perhaps it would be a good idea to have a talk with an anesthesiologist well before your colonoscopy, to discuss your concerns.  I have never had an anesthesiologist present for either endoscopies or colonoscopies, usually just my gastro and a specialised endoscopy nurse. This last endoscopy was actually done by a Registrar Physician, who was supervised by my Consultant Gastro. However, I live in England and our protocols may be very different to those in the USA. Interestingly, when I went for the endoscopy in July, I was given a form explaining conscious sedation, and no sedation, but could choose which I wanted.  Seemed it had something to do with recovery time and needing someone to take you home, after sedation...I suspect it was really about resources, as the recovery room was absolutely full when I was there. But, there again, we do have socialised medicine and do not pay for any medical treatment, and now I am over 60 yrs, drugs are free too.

Good luck, and hope you find the answers to your concerns.
Liz.

[Jack54]

Thank you for your kindness Liz. I don't think that anyone understands my question, and I don't know why.

Under general anesthesia, you are given, among other mixes of drugs, a drug that paralyzes you, so you don't move during surgery. You are also totally unconscious and cannot breathe without being on a breathing machine. I had a very bad experience with this type of anesthesia, as I mentioned above.

I suspect that my current gastrofellow is being overly cautious because I passed out due to low BP the last colonoscopy that I had. That was my second one. I had no problems and was totally asleep for both of them. Yet it was conscious sedation that put me to sleep, not general anesthesia.

I am going to call my doc and voice my concerns and if he doesn't agree with me, I will go back to my first gastrofellow :)

That is what I should have done to start with :)

Oh yeah, I have had 2 endoscopic analyses myself. One to find an ulcer and one to show that it was cured. On the first one I woke up during the first part of the procedure and it felt like they were trying to ram a Rubik's Cube down my throat! So, bless your heart for going through this without conscious sedation! It sounds like a nightmare for sure....

Thanks so much again,

Jack

[lizziecee]

Having had Crohn's for some 38 yrs and too many colonoscopies and endoscopies to remember, I have always had "twilight sedation"..my BP is often as low as 88/56, but as the gastro puts the needle into my hand, I don't remember anything until I am woken up in recovery with a cup of tea and a biscuit (cookie). Never had a problem with airways, but do remember having endoscopies without any kind of sedation, and they were horrendous.

Jack, from my 3 yrs of experience of Medhelp, the paid doctors here do not usually respond to secondary posts...just wish they did. Medhelp? are you there? Why do we pay for these posts, but never get any follow up?

Take care Jack.,
Liz.

[Jack54]

Kevin, in my case, there is no concern about maintaining my airway. My doctor's concern is that I will pass out due to low blood pressure when I am given the conscious sedating drugs.

I think a competent gastroenteroligist would refine how these drugs are given, and use conscious sedation, instead of having an anesthesiologist put a tube down my throat and placing me under general anesthesia.

I have normal BP controlled by medications. Please comment just as to whether you agree with me or not. I do not wish to take up your time.

Thanks again,

Jack

[Kevin Pho, MD]

Typically colonoscopies are done with conscious sedation.  However, if there is concern about maintaining the airway, then general anesthesia is needed.  

I would discuss your loss of consciousness with the anesthesiologist.  I cannot make recommendations over an internet forum, but the anesthesiologist would recommend the best method of sedation for your procedure.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com