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Thursday, July 31, 2014
General anesthesia vs. twilight for colonoscopy
I am getting a colonoscopy in a few weeks and was told I should opt for general over twilight due to me taking luvox 100 mg, BID, xanax .5 mg and TID for about 8 years now. My psychiatrist seems to think I should be fine and not wake up with the Versed. My question is which is safer general or twilight due to the medications I am taking? Also, does general always require intubating?
Please refer to other questions already published on this topic. Luvox (fluvoxamine) is an antidepressant (like Prozac). Xanax is medication similar to Valium. Both are in common use and there is no reason why either general anesthesia or "twilight" would be preferred on the basis of taking those medications. Versed by itself does not produce general anesthesia except in very large doses, so you should not expect to be unconscious if this is the only drug used for sedation during your colonoscopy. The drugs used for sedation/anesthesia for colonoscopy can be administered in low doses, producing mild-moderate sedation, or higher doses, leading to deep sedation or general anesthesia. General anesthesia does not always require intubation of the trachea. In the ideal situation, an anesthesia provider assesses you, your health issues, and your preferences, and tailors the technique appropriately. The plan may also need to change, depending on your response to the medication. Unfortunately this is not necessarily cost-effective and many US insurance companies have restricted what they will allow (or at least pay for).
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University