Sedation FAQs

For more information see our Procedural Sedation page.

Also see Procedural Sedation

The ability to tolerate an unsedated upper endoscopy depends largely on the sensitivity of your gag reflex and your general anxiety level about the procedure.  If you are highly motivated to avoid sedation and can wiggle two of your fingers in the back of your throat for a few minutes without gagging or retching you may be a good candidate to try unsedated endoscopy.  On the other hand, if even the thought of fingers in your throat makes you gag it is unlikely that you will tolerate the exam without sedation.

The ability to tolerate colonoscopy depends on factors relating to your sensitivity to anal and rectal manipulation, manipulation of the colon and its supporting tissues, and to the amount of manipulation of the colon necessary to complete the exam, which is quite variable from patient to patient and difficult to predict before the procedure.  Additionally, the need for sedation in colonoscopy depends on the technical difficulty of the exam, which also is variable and hard to predict.  In general, thin woman tend to be more difficult to examine than overweight men, though this is not universal.  A prior hysterectomy also seems to predict a more difficult exam.

Propofol provides much more flexibility in meeting sedation needs than traditional sedation with fentanyl-midazolam because of propofol's very rapid onset and short duration of effect.  With propofol it is possible for your doctor to take you "deeper" for one to two minutes during what might otherwise be a painful insertion of the colonoscope through the left side of your colon (the part of the exam most often associated with discomfort) and then "lighten you up" for the remainder of the examination.  If desired, propofol sedation can be discontinued on reaching the highest part of your colon (the cecum) and you can be allowed to wake up and watch the procedure during the instrument's withdrawal, which is generally not uncomfortable.

Also see Procedural Sedation

Will I remember anything?  I am scared of feeling pain and I want to be "out."

Most of our patients prefer not to remember their examinations.  Sedation with propofol is more likely than traditional endoscopic sedation (midazolam-fentanyl) to succeed in providing a pain-free examination, but even traditional sedation is effective in accomplishing this goal in most patients.  It is very unusual at our center for patients to report the recall of any significant discomfort at the completion of their procedure.  It is important for you to discuss your preferences regarding your sedation with your doctor, who will work with you to incorporate your wishes into your sedation plan.
 
Also see Procedural Sedation

Can I drive home after sedation?

While the medications we use are very short acting there is not adequate data in the medical literature to confidently determine when psychomotor function returns sufficiently to allow safe driving.  We instruct you not to drive or operate potentially dangerous machinery until the day after your procedure.

What if I want to see my colon...is that possible?

Just as some patients ask not to remember anything, others want to see some or all of their exam.  You should discuss this with your doctor before the examination.  In most cases patients sedated with propofol can be allowed to awaken during the withdrawal of the colonoscope, once the cecum has been reached.  Colonoscopy is not usually uncomfortable once the cecum has been reached.

Also see Procedural Sedation

I always vomit after anesthetics...sometimes for hours.  Will the drugs you use cause this reaction?

Virtually never.  Low dose midazolam and propofol do not cause nausea.

Will I say something I shouldn't or divulge a private secret during sedation?

This seems to be a common worry.  It is not unusual for patients to become talkative when under the influence of sedative drugs, and they often are surprised to hear things that they chatted about as they were "going under," during the exam itself, or as they recovered.  Personally speaking though, in 25 years of endoscopy practice none of my patients have divulged a personal secret or anything else that they in retrospect thought was inappropriate during the examinations I have performed.

I had sedation for endoscopy or colonoscopy this morning and now I have fever, chills and muscle aches.  What is going on and what should I do?

These symptoms are not expected and should be reported immediately to your physician.  If you also have throat, neck, chest or abdominal pain or tenderness, an endoscopic complication such as perforation must be assumed to have occurred until proven otherwise.  Early diagnosis and treatment is key to achieving the best outcome.  If you have no other symptoms your fever, chills and muscle aches may be due to the sedative administered for your procedure, particularly if you received propofol.  The FDA and CDC are currently investigating clusters of propofol-associated fever from around the country, as discussed here.  Evaluation and treatment for bacterial sepsis is recommended if this problem is suspected.

I read about the Las Vegas outbreak of Hepatitis C related to nurse anesthetists reusing syringes and propofol vials.  What are your injection practices?

We use only single-dose 200 mg vials of propofol at our facilities, which are not shared.  If a patient needs more than 200 mg of propofol for their procedure a second new vial is accessed with a new needle and new syringe and the entire 200 mg is drawn into the syringe.  Whatever amount is not needed to complete the procedure is then discarded.  We do not reuse needles or syringes, or use single-use medication vials for multiple patients.

Also see Procedural Sedation