Colonoscopy - which drugs are better?

Evo

My last colonoscopy I had demerol and versed, no pain during or after, PLUS I felt the best I've ever felt for the rest of the day (thank you Demerol).

But my new doctor prefers propofol. It puts you to sleep, unlike the demerol/versed, where you are conscious, but feel no pain. You are supposed to have a completely painless experience (due to being asleep) and it wears off quickly.

I've spoken to several people that have had colonoscopies and said that when they woke up they had terible gas pains and don't look forward to doing it again.

I had no gas pains and I was wanting another colonoscopy the next day.

I'd like to hear from people that have had colonoscopies, or know of experiences of patients that have had either so I can try to make a decision on which way to go this time. I think this doctor plans to do a more aggressive colonoscopy than my first doctor and maybe propofol is a better choice.

bobze

Propofol is good because it is short acting, both for induction and for recovery. Its a hypnotic and doesn't provide any analgesic effects so if the doctor was "rough", it certainly is possible there could be some discomfort or pain afterwards. If you are worried about post-scoping pain talk to your doctor about it. They can add a short acting opioid, like fentanyl.

If you prefer to remain conscious they can use midazolam and fentanyl.

Both combinations (midazolam+ fentanyl and propofol+fentanyl) are regularly used for minor or outpatient/same day procedures.

I am guessing (without knowing your specific circumstance) if he wanted to knock you completely out they want to get a look a "little higher up", which can be discomforting. When the patient is under deep sedation rates of finding polyps and examining the bowel are more productive. So it maybe, if this a new doc for you, he just prefers to do it differently as per the evidence (see link).

Evo

I can't read the link, but had read that could be a reason, since the first doctor only went 2/3 of the way and he found 3 polyps that were still in the precancerous stage, I think this doctor wants to check higher due to the pain and other symptoms. I'm also having an endoscopy at the same time due to secondary achalasia due to the nissen fundoplication I had. It's like having heart attacks over and over. I had dysphagia before the surgery and continue to have it. Also, the hiatyl hernia they repaired has returned and the "wrap" has slipped.

Thanks for the advice on the fentanyl.

Moonbear

The endoscopy might have more to do with knocking you out ompletely, to suppress your gag reflex. You know the drill around here...discuss it with your doctor if in doubt. There's nothing wrong with asking why he wants to use a different med than your previous doctor. If there's no good reason other than that's his routine, or most patients prefer it, then you can discuss other options. If there's a good reason with your specific procedure, then go with his recommendation.

Evo

I've had 2 endoscopies with versed, I woke up during that last one, terrible, they took forever to administer more, the doctor told the nurse that I wouldn't remember. HA!!! I remember every horrible minute where I was gagging and thrashing as much as possible to get their attention.

I would like to hear from some of the members that said they had bad experiences with colonoscopies and if they know what was given to them. several members in chat told me theirs were bad, so I'd like to know what they had. I loved my colonoscopy.

D H

I've had one, but all I remember is the juice taken orally the day before. That was not pleasant. The juice injected into me the day of: I don't remember a thing. My memory is a four or five hour blank spot. There were no side effects -- that I can remember.

Evo

Maybe you had the propofol. I was conversing with my doctor thoughout my colonoscopy.

Astronuc

Propofol is wonderful. Best sleep I've had 34 years.

Moonbear

Versed has amnesic properties. Some people remember what happens, and most remember part of it as they go under or come out of it, others will forget what happened even for a while after they come out of it even though they're conversing like they're fully awake. They might think they were completely knocked out because they don't remember anything. It's mainly a sedative to calm you, not as good for pain control, so is usually given with another drug for pain control. Its amnesic properties mean if the pain control isn't enough, you forget it ever happened, not that you were necessarily comfortable the whole procedure.

bobze

Yeah, that's Midazolam--What I was pointing out above, they normally give it with fentanyl. When the anesthesiologist want to do conscious sedation sometimes they actually use all 3 (midazolam, fentanyl and propofol).

Its nice also because the benzo and opioid affects are drug-reversible as well.



Evo-

My apologies, I didn't notice I was on my VPN when I pulled that article on medscape, study-brained at the moment

Anyway another link for you on greater efficacy of polyp discovery while using deeper sedation.

And on a personal note to your question on experience:

I had a colonoscopy a couple of years ago. They kept me conscious and actually used propofol and fentanyl (note you can still do conscious sedation with propofol, they just don't use a bolus and use a smaller dose to cause "disassociative feelings"(they often use ketamine for this in peds)). Their mistake, I vaguely remember the conversation I had with the GE. After telling him I was on my way to medical school, he foolishly asked "what kind of doctor do you want to be". My reply of course, scope fully up my back side; "Not an a$% doctor that's for sure". Valuable lesson learned--Maybe its better for the patient to be unconscious

D H

I knew that I was conscious because the doctor said that that the intent. I don't remember anything, or anything for quite a while later. Apparently I said I was fine. Very fine! Good enough to drive home even. No problem! My wife fortunately thought otherwise.

My wife has also had colonoscopies, with similar continued amnesiac effects. She too felt fine, very fine! After her first one she did chores including bill paying. She ended up paying some twice, including the mortgage. She told me to keep her away from her computer and the checkbook after her second.


Ouch! Doctors don't like taking sh*t. Isn't that one of the reasons for the clean-out juice the day before?

rhody

You couldn't wait for another one, lol. Seriously though, lets hope your Dr is really good with that evil snake like thing, mine is. His assistant told me he can spot abnormalities smaller than the tip of a very fine pen in the lining. That is what is important. I don't remember a thing either and wasn't all there the afternoon after. The room where they did the exam had rock music playing, nice, but someone forgot to pull the curtain over the evil snake array hanging on the wall in the corner, , that raised my BP a few points I am sure. Good luck, I will cross my fingers that everything goes smooth, well for you.

Rhody...

Evo

Thanks everyone. And thanks Bob for the link! I guess I will go with the propofol and be put to sleep.

turbo

I had propofol for mine, Evo, and I worked out OK. Out like a light!

rhody

Evo, Evo... concerned, how did the procedure go ? Earth, PF collective calling Evo...

Rhody...

Evo

I haven't had it yet. They won't release me from the hospital unless I'm signed out by someone that will drive me and stay with me. They won't even allow me to take a taxi home. So I may have to wait until Evo child has spring break, she's so busy right now.

turbo

Spring break? You need some sort of support structure, absent nearby family and friends. Is there anything we can do? Even something as simple as gas-money for dlg?