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Anesthesia

Type of Anesthesia for colonoscopy

10/15/2007

Question:

I have an upcoming colonoscopy and was told that I have several choices as to the type of "anesthesia" that I can get....first was some sort of "conscious cocktail" of painkiller and amnesia drug that is usually effective,and a second, "deeper" drug "diprivan" administered by an anesthesia person and thirdly nothing at all. The doc says that choice one works well on "most people" but not on all, choice number two (the diprivan) is great but expensive, and choice three (nothing) is only the choice of a small percentage, but the "safest" option.....This is just a screening test due to bad history, no emergency...just from a safety standpoint, is there a significant difference of risk between the three choices? I`m scared to death of the idea of any anesthesia and am leaning towards nothing if the first two are at all risky. Thanks

Answer:

Thanks for your question.

Your doctor has provided a not unreasonable summary of the choices except that he is not balancing risk against benefit.

Options one and two are very safe in the hands of any well-trained clinician using appropriate monitoring and clinical judgment.

Option three (no sedation at all) is the safest from the point of view of side-effects from anesthesia (obviously). But here's a question. Do you want the doctor to have the best possible chance of giving your colon a thorough going-over? I assume the answer is yes - else why bother having the colonoscopy? The best possible conditions for the doctor doing the colonoscopy are:

1. The patient is asleep (immobile and not wriggling around)

2. The endoscopist does all the time needed to complete the procedure with thoroughness

There is at least one study showing that in patients who get the deep sedation technique, more polyps are found in the colon than those who get the usual "cocktail". There are certain parts of a colonoscopy, such as when the scope gets to an area called the splenic flexure, that can be really very uncomfortable.

For more information:

Go to the Anesthesia health topic, where you can:

Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University