Oral Sedation for Colonoscopy

[intrepid]

I am preparing for a routine cancer screening colonoscope, male, age 57, no heath problems or adverse history.  I have had two prior unsedated sigmoidoscopes and I was  able to handle the minor discomfort well.  I am very comfortable with this procedure and it does not bother me.   I do not want IV sedation for the colonoscope for several reasons.

Given the possible discomfort, in lieu of doing the procedure totally without  sedation; I would like to try using mild oral sedation accompanied by a  pain killer.  Based on prior experience with vicidin (dental pain) and xanax (pre dental anti-anxiety medication)  @ 0.75 mg; I am considering that combination for the procedure as follows:

3    0.25mg xanax tabs one hour prior =   0.75 mg total dosage

with

1 Vicodin ES  (7.5/750) one hour prior (for pain)

Is this a good viable combination ?    Given there is some additive  interaction between these two, are the dosage levels appropriate?  Is there a better drug and/or combination we should consider?  What is the most common oral medication scenario being used?  

The reason I am considering these two is that I tolerate them well (individually) although I have never taken them in combination.   I also have a fairly high tolerance for both drugs (they seem to have minimal sedative effect at those levels, the vicidin does work very well for me on dental pain). I do not want significant amnesic effects, I want to be fully aware of the procedure and have recall.

[Giblett]

I would strongly suggest not using oral sedation for one reason.  I just had one.  You will feel quite a bit of discomfort when the doctor gets up into your colon.  If you use an I.V sedation, you won't feel this as much and you won't remember the test. My doctor let me know when he was about to go into the upper part of my colon and I do remember grunting as if I felt it, but I don't remember it.  If I had to do the test again, I would choose I.V. Sedation. preparing for the test is awful in it's self.  And I do remember that.  what an experience. Good Luck

[nadia]

I completely agree with Giblett.  The prep is nasty enough, and the IV sedation causes no discomfort whatsoever.  If you want to watch the colonoscopy take place for recall, then ask for less sedation.  I was given .5 mg of ativan to relax me a little prior to the procedure.

[intrepid]

I appreciate your comments and interest Nadia & Gib; but you miss the point.  I adamantly WILL NOT accept IV sedation.  If necessary I will go totally without any, but I prefer some oral pain relief if possible.  I want minimal sedation and no amnesic effect.  What I am hoping to get is suggestions and experiences/recommendations for oral sedation that meets that objective.  In my prior sigmoidoscope exams, the spleenic flexure was passed successfully, so I am familiar with the discomfort there. Obviously they will be taken with minimal water, and my physician will have to approve and oral medications.  

Thanks  :)

[jason7]

I've had 3 scope down the throat and one colonosopy.
I had a IV sedation for all of them and didn't fell much pain.
If I were you I wouldn't be as scared of the IV needle as much as that scope.
good-luck

[Giblett]

I can tell you from experience, as a nurse, Sigmoidoscopy and a Colonoscopy, are not the same.  A colonoscopy goes all the way into the colon, where as the sigmoidoscopy goes only into the desending colon. Quite a big difference. But if you insist on getting one without sedation, you are going to feel alot of discomfort. Good Luck anyway.

[GI.PA]

( I had tried to post earlier without success so I apologize if this posts again)

I can see a potential problem with oral sedation.  You are going to want to be more sedated than what oral sedation can offer.  It is extreamly hard to plan on the maximum effect of two oral medications occuring at exactly the time the colonoscopy occurs.  My concern is that while waiting for your turn, the drugs max out and now we are scooping you off the floor.  My other concern would be, we all know you have a high pain threshold, but what if the pain gets to be TOO much?  Do you stop?  Do you then consent to sedation (something you cant do if you are mentally not all there from your oral meds)?  Do they scratch the procedure and reschedule?  Do you already have an IV in (just in case) and have an understanding with your doc that sedation will be only if you request mid-procedure?

The bottom line, you need to talk this over with the GI doing the procedure.  If you have yet to meet him/her, schedule a consultation to discuss these concerns.

GI.PA

[kimbacat]

it sounds like it is the amnesiac aspect of the meds that you don't want.  usually, docs will use 2 meds for conscious sedation, like demerol or fentanyl and valium or versed.  talk to your doc about using meds that have the least amount of amnesiac properties to them.  demerol or fentanyl alone shouldn't cause amnesia.  the versed is usually the culprit with that.

like gi.pa said, the timing of the oral meds can't be finessed to hit at the time of the scope.  besides, you would be considered impaired if you took them ahead of time.  they might not allow you to sign a consent form and then the scope would be a no-go.  plus, the docs around here tape or save the whole scope on cd-rom and print off lots of pictures.  so, if you want to see it, you can always view it after the fact.

[ekd]

Last Thursday morning I woke up to quite a bit of bright red blood mixed with diahrea along with cramping.  I thought it might be hemorroids (hemorrhoids) but it didn't go away, only got worse.  We have no health insurance so the next day my husband took me to the public hospital.  They did a physical check, (found blood), drew blood, and hooked me up to a IV of clear liquid that they told me was to strengthen my blood.  They also took 4 xrays of chest and stomach area.  They reported that my blood count was good and they didn't see anything on the xrays.  They prescribed Cipro 500 mg. twice a day for 3 days.  I just finished the medicine and I feel worse now than I did before I went.  I think the Cipro gave me worse diahrea aggravating whatever is bleeding up there and the cramping is terrible.  I have to wait for my next appointment to come in the mail.  I know I will have to get a "scope" done.  I see you all talk about different kinds of "scopes".  The doctor referred to it as simply a "scope".  Do any of you know which one it may be that I have to get done?  Also, do you all recommend taking an IV for all types of scopes?  My sister had one done and they didn't give her anything.  Also, what kind of preparation do they do that is so bad?  Sorry I have so many questions and really appreciate your help.

[Canyonbabe711]

I am not sure exactly what your reasons are for not wanting IV sedation. Obviously you feel you have good ones but I just had a colonoscopy on Wed. without sedation and I would not go thru that again for anything. Because I have emphysema I was only given a smidgen of Versed to relax, yeah, right! I was awake and in pain 50% of the time and I have a high pain threshold. I kept yelling stop or knock me out and he kept saying he was almost done and the bad part was over. Not true. Fortunatly all was well and I don't have to have another for maybe 5 years. In their dreams. Never again. Have had sigmoids and endoscopies without sedation, piece of cake. Not this, I assure you.

[Giblett]

I can understand where you are coming from.  My good friend is A G.I Doc.  He said he never would put any of his patients through a Colonoscopy without sedation.  And quite frankly, it is not bad at all. I had Demerol and Valium with mine. I don't remember a thing and it is probably just as well.
The only thing I hated was the Prep for this. I drank the Phoso-soda drink with Apple Juice. It tasted just like salt. And being on a clear liquid the day before. I will never drink chicken Broth again. I can't even get near the smell anymore. That is the worse part of this proceedure. The Prep. I would do the colonoscopy under sedation anytime.

[ekd]

Thank you so much for the information on the "scopes".  My sister said she wouldn't ever do it again either.  She had naively, drove herself, and had to drive home alone afterwards.  She said it was the worse thing she ever went through.  If you happen to read this, was the Demerol and Valium administered through an IV?  Just wondering!  I guess I'm going to stop the chicken noodle soup now if thats coming soon.  Just to let you know, I have only passed blood twice this morning and so far, not again.  I don't have the cramps today.  I definitely think the Cipro he gave me was aggravating the problem.  Now if only the bleeding would stop.  Good luck to all of you.

[Canyonbabe711]

I am surprised they would even do it on your sister without a driver. That was made very clear to me that even though I would no be out  I still had to have someone with me. In fact, she had to sign the release instructions.. I guess they figure if they give you anything you are not in your right mind. I was in my right mind and ready to murder the Dr. when he came back in to give me results.

[Giblett]

Well, I am having my 5th procedure for my fistula problem. He is placing a Seton on Friday, and with out anesthesia.  Guess I will be getting first hand knowledge of what this will be like.  He thinks I might be able to handle it.
We will see as I am not into pain. Has anyone had this?

[arlmon]

I had a routine colonoscopy last Feb/02. The preparation wasn't that bad and neither was the procedure. I'm not saying it was a picnic, but I will definately do it again in 4 years around. My doctor gave me a mixed injection of demerol and valium - into a vein and left it open with a butterfly (in case I needed more). I didn't have any I.V. I was a little groggy, but I was up for most of it and watched some of it on the screen. I remember saying that my colon wasn't as nice as Katie Courics! I just felt a little cramp when the doctor went around the loop. Otherwise, it didn't take very long and I rested a bit afterward. I don't think for one minute that I would have done it without any meds. Some people (like my husband) slept through the entire procedure. I think the word colonoscopy scares people, but it's well worth having, that's for sure!!

[Baseball_Mom]

I had the seton placement that you were referring too about a year ago for a fistula.   I can't imagine your doctor performing that procedure without any anesthesia at all.   The procedure itself took about 5 minutes and I wasn't in too much pain afterwards.  But let me warn you, I went for weekly checkups to my doctor to have the seton tightened and about came off the table every time.  Since having that procedure I have had to have reconstructive surgery down there as well as 3 more fistula repairs.  Hopefully the Seton placement will be the fix all for you.  You will be in my thoughts and prayers.  If you have any more questions, please don't hesitate to ask.  Best of luck to you.

[ToughGuy]

Hi Intrepid,

Don't be such a scardy cat!  I am M/53 and had my colonoscopy (my first) without any sedation of any kind, because like you, I didn't want to be sedated or medicated in any way.  I wanted to be conscious at all times...and you know what - NO BIG DEAL!  It has a little discomfort, but it is not really painful and I will go back in 5 or 10 years without an problem.  And you know what, in the Eastern European countries, like Slovakia, they never give any kind of sedation to anyone as a matter of principle (I am not sure about children).  I know this because my lovely fiancee, final 6th year medical student, tells me that is what happens over there!  So take the plunge, cat!

[JWB celiac]

Intrepid

Oral sedation will be fine, just let your doc decide what is best instead of gathering your own ideas.  I've had a colonoscopy when I was 19 to diagnose celiac disease, which could be what ekd might very well have, and now am having a follow up one performed now that I am 24.  I prefer the IV sedation cuz you are out like  light, but you are correct in that you do not remember much...or whoever said that is correct.  Just dont worry about it too much, and it is much different than your other scope so I would try not to compare the two quite as much and just see what your doc says.

Everyone should get tested for Celiac Disease though, if you're having a colonoscopy your GI doc can tell you about it and do a simple blood screen.  www.celiac.com for more info.

Good luck everyone

[dvoyre]

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