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Mental Health

Anxiety about anesthesia

12/28/2007

Question:

I needed to have a colonoscopy at age 40 due to a really bad family history of colon cancer...I`m now 52 and still have not had the test because I have a really morbid fear of "conscious sedation". This is not an anesthesia question; I`m a pharmacist and understand how safe the procedure and the drugs use are......I just can`t get past the idea of the conscious sedation part; the amnesia part really freaks me out...and I can`t find a doctor who won`t do the test without "conscious sedation". I even met with an anesthesia doctor and we had a long discussion as to which drugs were best, how safe it was etc.....I scheduled the test, did the prep, but as soon as they wanted to start the sedation, I refused and left....I just couldn`t do it; I could not stand the idea that for 30 or so minutes I would be having a procedure that I would be unlikely to remember and have no control over....I guess that I`m a control freak; God knows that I`m not afraid of the drugs....in the past I have taken the same sedation drug (orally) for insomnia and have had the IV narcotic when I had a spinal procedure..but that was via a pump that I could control.....O.K., the GI doc, the anesthesia provider (and we discussed every possible drug, but they insist on some sedation), the nurses have all been super nice to me and tried to explain how safe this conscious sedation is (and, from my professional background, I know that they are right).......But as soon as I hear "this is a little something to relax you", I freak out and yank out the IV...... Oh, and by the way, the nature of the colonoscopy does not bother me at all; I begged for them to do it without drugs, but no dice...Would seing a psychiatrist help? My primary care doc says that I need to have this test done (12 years late)...any suggestions?

Answer:

Thank you for your question.

Intellectually, you identify the need and importance for the colonoscopy. However, your subjective experience and general aversion to this have obviously prevented you from following through. Unfortunately, not following through with the colonoscopy can have serious medical consequences.

I commend your primary care physician, anesthesiologist, and gastroenterologist in their willingness to work with you and attempt to accommodate your request. Your description is unclear on what exactly has "freaked" you out in the past or why.

A few options and questions.

I totally understand how your team of physicians would be uncomfortable with a colonoscopy without any medications.  Is there any alternative to conscious sedation that would be clinically safe and suit your preferences? Are there any strategies that would make you more comfortable during the process (e.g., a family member present)?

If anxiety is a large component, one option is to consider clinical hypnosis. You could attend outpatient sessions of hypnosis with the specific intent of decreasing procedure-based anxiety. Consult the American Society of Clinical Hypnosis for a local referral.

Best of luck.

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Response by:

Ram Chandran  Kalyanam, MD Ram Chandran Kalyanam, MD
Clinical Assistant Professor of Psychiatry
College of Medicine
The Ohio State University