Wednesday, April 23, 2014
Colonoscopy with Propofol or with Nothing?
I`m a 49 year-old female with a first-degree relative who died from colon cancer at an early age, and I realize that I am late in getting a colonoscopy (9 years late). I had several bad polyps removed via flex sig last year and now need to get a colonoscopy done. I would prefer to get the exam done unsedated because of a previous bad sedation experience (became combative from IV diazepam and the experience was awful). I realize that other drugs are available, I just don`t want to risk them if I can avoid it. One gastro told me that propfol is great, but another told me it`s not such a great idea for colonoscopy because when a patient is deeply sedated the often can`t respond to pain such as when the scope gets looped and is about to perforate the colon. Yikes! The nurse who works for the gastro who doesn`t like propofol says (confidentially) that his negative opinion stems from having to wait for the anesthesia nurse to arrive when a patient wants MAC and this slows them down.
I`m confused. I don`t think that midazolam is an "evil" drug, I just think that it too close to valium for me to consider; I read a lot of opinions from people who consider the amnesia issues to be a big deal...My question: assuming that the benzomidazolam will be out since I`m allergic to valium), right? my choices will be propofol or nothing. From an anesthesia point of view, could you please give me your opinion of colonoscopy with propofol or with nothing? One GI doc says that a sedated patient is more likely to get perforated; but he also says that a sedated patient is more likely to get a "quality" exam because they tend to rush when the patient is in pain. His associate offers the opposite opinion: deal with the pain of an unsedated exam because it forces them to slow down and you will get a better exam. Sorry for all of the detail; they just really have me confused. Thanks.
This is a controversial issue and you've captured the different points of view very well!
Here are a few points that may or may not help you decide:
Perforation of the colon during colonoscopy is very rare and probably has more to do with the operator than the type of anesthesia.
An anesthesiologist or other qualified provider sedating you for a colonoscopy can offer you a very comfortable experience, using the variety of drugs now at our disposal. If you have an aversion or preference with regards to a particular drug this can usually be accommodated. Propofol, used appropriately, is safe, effective and provides complete oblivion during the procedure (most people like that idea).
Most people find the preparation for colonoscopy (purgatives to clean out your bowel) much more difficult than the procedure itself.
A colonoscopy, especially when risk factors like a strong family history exist, can save your life. Just go and get it done, as soon as possible!
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University