Did you know what medication alternatives are available for colonoscopy sedation?

Part II: of the Medications for Colonoscopy Issue

Most of the time when having any types of procedures performed by our physicians we as patients don’t ask enough questions. We just ‘assume’ that our doctors would do the right thing or the best thing automatically for our well being. 

The trouble is that many times physicians and/or staff follow standard procedures that are simply the procedures that they are used to following and may not always be the best procedures for us as an individual patient. And you must also keep in mind that many times things are done that make it ‘easier or quicker’ for the physician and/or staff, but may not make our recovery ‘easier’ for us. The trouble is, that there are many things in medicine that just ‘depend’. Depend upon the patient, depend upon the situation and ‘depend’ upon the procedure. So your goal when getting any type of procedure performed is to ask the right kinds of questions so that you are well informed and know your options. And so that you can then make an educated decision about what types of medications would be best for your own personal situation, and not simply best for the convenience of the doctor or hospital.  Here’s an article regarding understanding medication options that you may find helpful.

Friendly Male and Female Doctors on White

Ok, let’s make this easier by giving you some examples. Particularly in the case of sedation options for having a colonoscopy. We’ve written some previous articles about 1) Preparation for a colonoscopy,  2) Medications for colonoscopy: in part one of our article we talked about one of the most common combinations for colonoscopy sedation, and why you should learn more about how these drugs act both when they are given to you and what possibly could happen when they wear off. And 3) In this article that you are now reading, we’ll  discuss some alternative sedation combinations that can be used during a colonoscopy procedure. Some of these options, keep in mind, may not ever be brought up by your physician unless you ASK QUESTIONS. So find out in advance (not on the day of your procedure), what medications are available, and ask your doctor about options if you don’t feel comfortable with the ‘standard’ medications that are ‘normally given to  ‘everyone’.  You’re not everyone, you’re you, and an individual,  and what’s best for everyone may not be in your best interest.

So in our earlier article about sedation options for colonoscopy we talked about how in most cases doctors will give a combination of Fentanyl and Versed for colonoscopy sedation. What most patients do not know or are not told is that there are other options for sedation during the colonoscopy procedure. While it may be true that for most patients Fentanyl and Versed may work perfectly fine, there is a growing number of adverse patient experiences  that I am beginning to hear about both from nurses in the field and from patients that is concerning regarding the use of Fentanyl and Versed. Interestingly enough, Fentanyl  and Versed may be the ‘favorites’ among staff and physicians, (to use on their patients) but in a growing number of patient reviews and patient reports, when things go wrong with this combination, it has been a traumatizing experience for patients.  Incidentally, I am hearing from some of the health care providers that actually perform these procedures that when they themselves have colonoscopies, many of the health care providers that I am hearing from are choosing NOT to use the Versed and Fentanyl combination. Wonder why? Some engineers have reported that they have lost memories that involve their ability to perform their jobs after being given Versed.  Perhaps that’s why some physicians won’t take Versed themselves. Just understand that proponents of these medications will tell you they give them to thousands of patients and it is normally a “well tolerated procedure” etc. Again,the question is not whether you would “tolerate” this medication or drug combo well, but shouldn’t you be informed about the possible drawbacks to using it?

So let’s re-emphasize that point as I’m sure I’ll have lots of emails from those who want to keep the issues with Versed low profile.  The purpose of this article is not to debate whether you or your physician should use Fentanyl and Versed, or even one of the other alternatives, but to make you, as the patient, aware that there are options in most cases for medical procedures in terms of what medications are used, and unless you are being wheeled into an emergency room already unconscious, it is my belief that you should know about these options, and you should be aware of what medication options you have with any type of medical procedure that you may be having performed. So this knowledge you will gain can also be applied to other procedures you may have in the future, not just a colonoscopy.

Here are the  most commonly used colonoscopy sedation medications:

1.Fentanyl and Versed:  Versed is amnesiac type of drug which means that in most cases you won’t remember what has been done to you. You ay be in pain but will be unable to do anything about it.  See part I  of our article on colonoscopy sedation medications for more information about this combination.

2.Fentanyl, (a pain medication)  and Demerol (also a pain medication) this combination has been used in cases for pain control but where the patient will remain aware and be able to view the colonoscopy monitor and/or converse with the doctor during the procedure.

I have read that Katie Couric was given Demerol during her very famous televised colonoscopy procedure but I have not confirmed this. If anyone knows what medication Katie Couric was given during her colonoscopy let me know and I’ll update this article!  It would not  do to have a news anchor be asleep during her television  segment, thus she had to be given either some medication or medications that would not totally put her to sleep. Due to some reports of possible issues with seizures when using Demerol, it is not generally a ‘first choice’ among physicians any longer, but used to be used more frequently.

3.Fentanyl and Valium – We will post a video of a patient  soon which shows a patient  who underwent a colonoscopy and whose Doctor agreed to give him a combination of Fentanyl and Valium during the procedure so that you can actually see how the patient could converse with the physician during the exam. This patient who agreed to share his colonoscopy experience with us wanted to be aware of what was happening during his exam. He absolutely wanted a physician who would respect his wishes that no Versed was used, but the patient had agreed  to receive medication to prevent pain.  The other positive about this patient’s experience with having Fentanyl  and Valium used during his
procedure  is that the patient was able to converse with the doctor after the exam and could remember the conversation.  The patient recovered quickly, was able to leave the hospital much sooner than those given other types of sedation, was also not groggy during the day and even went dancing later that night!  Note: In order to get this combination of medications the patient researched the procedure, researched his provider, the physician who performed the exam, and worked it out with the physician ahead of time i.e.: before exam day that he would not be taking the Versed. So it is not something that just happened by accident, it had to be planned and discussed beforehand. The patient’s requirements were that he would be given medication for pain but wanted to be aware of what was being done to him during the procedure, and he wanted to be able to view the monitor during the procedure. He also didn’t want to lose an entire day of work after the procedure or feel “drugged” up for the rest of the day.

4.Propofol is an  option for those patients who would like to be totally asleep during the procedure. This is an actual anesthesia agent, fast  acting, so you won’t remember the procedure but will wake up quickly, aren’t sedated or nauseated for long periods of time, can be discharged generally within 30 minutes and many patients report feeling like they’ve had a power nap. Patients report great satisfaction with propofol and it is used generally for the following reasons: 1) It is fast acting, and short acting, which means once you are given the drug it takes affect right away, but when you wake up there are generally no long term affects like with some of the other sedation type drugs. Patients can return to activities requiring clear headedness and being aware unlike some of the other combinations in which you may be feeling ‘drugged’ for hours.  Patients report less nausea with propofol than with other combinations of medications. After the procedure you will be awake and alert and able to remember your conversation with the gastroenterologist, unlike with some other combinations like Versed where you may have a conversation with your physician but will probably not remember it.  Disadvantage is that propofol requires a CRNA or Anesthesiologist to administer the drug to  ensure your airway and respirations are maintained during the procedure. Propofol is not a good choice if you would like to remain aware and alert and/or watch the procedure on a monitor.

Quick Fact Tip: When President George Bush had a Colonoscopy back in June 2002, the medication that the President received was propofol. It was also reported that the President was expected to have the procedure in the morning and then go running or exercising that afternoon. With some of the other types of medications that would not be possible. One “fun” way I like to question my physicians when investigating a test that has been recommended for me if I am contacting a physician as a patient  is to ask what medications would  the President would be receiving if he were having the same testing as what my doctor is recommending that I have. This way I can generally find out what options there are for medications that are fast acting. I’m personally not interested in taking any medicines which put me out of commission for an entire day or days if I can help it. So asking this question generally gets providers you’re working with to think along the lines of safety, and efficiency in terms of minimal down time for work etc.

Cost can be an issue with propofol because some insurance companies are not reimbursing for the use of propofol. This can vary depending upon the area of the country you are in, and your insurance carrier. Most patients report being more satisfied with propofol, but it can add to the cost of the exam. Note: some patients have written in and said that they had to pay extra for propofol (I’ve seen ranges from $125 –400 depending upon the provider and regions). Your costs could be different, or your insurance policy could completely cover the use of propofol at 100%, and we received lots of feedback for this article from patients who had to pay extra for propofol but who said it was the “best money they ever spent.”     The important thing isn’t actually that it is ‘too expensive’ as some providers use as an ‘excuse’ not to discuss this option with a patient. The point is that you as the patient should know in advance there are physicians that will perform exams with propofol and even practices where propofol is used as a #1 choice and that if you find a doctor who uses it regularly or who will use it upon request it is your right to know about it and make an informed choice with your doctor to see if it would be a good choice for you.  If you are comfortable with being totally ‘asleep’ during your procedure and don’t wish to converse with the gastroenterologist and/or see your exam on a monitor while it is being performed, then propofol can be a very good choice. If you wish to remain awake and know exactly what is happening to you during your procedure, or if you want to watch the monitor then you’d probably be much more interested in having a physician who would use Fentanyl and Valium, or Demerol or something along those lines. Your personal medical history may also be an issue in terms of which medications can safely be used so do have conversations with your doctor.   Give yourself enough time before your actual exam to find out what your options are with your doctor, (and not on the day of the exam, you must find out about this beforehand),  and then research the medications that will be given so that you understand in advance how they work and the possible disadvantages to each choice. All medicines can cause side effects but part of being an informed health care consumer is that you are involved in your choices when it comes to medications. 

Full disclosure about medications: There are a significant number of patients who have reported very bad experiences using Versed. There should be real informed consent meaning that patients should be told that Versed is given to keep you relaxed and make you forget, not just ‘here’s something to make you comfy’.  And patients should be told about the side effects and/or possible paradoxical reactions to Versed. If you ever are approached by any healthcare professional who comes at you with any medication and says they are “giving you a medicine to make you feel comfy,” then I personally would run as far and as fast away from that healthcare provider as possible. It is your absolute right to refuse the medication if you are not told what it is for and possible side effects and/or alternatives and to ask for and receive complete and full disclosure about what they intend to give you and what other options or other medications may be available.  It is your right to walk out of an office if you are not told complete information about a test. I was once a patient at a prestigious hospital, known as one of the best in the nation, and refused a radiology test because the doctor who ordered it should not have ordered it until after I had a particular type of surgery.  There was a clear medical reason to wait for the scan and not have a scan with contrast until after my surgery was completed. But the physician who ordered the test said it was ‘no problem’ the nurses whom I asked about it said it was ‘no problem’ to have the test and they were ‘sure’ that the physician had checked before ordering the test. To the contrary, so I can recall wearing one of those short little hospital gowns, sitting in a cold room and telling the nurse that I was not going to have the test until I spoke to the Radiologist. Luckily, I had my laptop with me, and so, sitting in the holding area for testing, in my hospital gown, I pulled up the medical research that clearly indicated that the test I was getting ready to have was not in any way, shape or form, to be given to someone before my particular surgery.  The Radiologist leaned over the table where my laptop was perched,  took several minutes to peruse  the documentation I provided and said, “’you’re right, you should not have been scheduled for this test before your surgery. I’ll contact your doctor and we will reschedule it.”    It was a moment I will always remember. Shouldn’t they have known this?  I was at one of the best places in the nation and I had questioned my original doctor about the test and was told it was not a problem. Later, armed with the actual research and my laptop I was able to show the Radiologist the opinions from other surgeons and facilities about how having the procedure was contraindicated at that time.  I got dressed, and walked out of the testing area, and knew then that the responsibility for my medical care and decisions from that point onward were going to have to come from a place of knowledge  and not from just trusting what anyone said no matter how many initials they had after their names.  Unless you are going in for some type of emergency treatment in which case decisions sometimes must be made quickly,  you can and should research your options in advance.  Healthcare professionals  should treat patients like adults, not like 2 year olds. We would tell a child we are giving them something to make them ‘comfy’ not a grown adult.

One rarely known or used resource can be the pharmacy staff. Call your local pharmacist or get to know one in your area and ask them about side effects of medications. Get online and research drug side effects and read about how certain medications work so that you are an informed patient.

For healthcare professionals:

Patients who use providers and who are cared for by nursing staff who offer full disclosure and alternatives to the ‘this is what everyone gets’ generally feel more satisfied with their care or procedure and are more likely to return to the provider and/or recommend that provider to a friend or family member. Even if the ‘alternatives’ take a little longer or are not the norm. Having an informed patient leads to better outcomes, and more referrals, and happier patients. It is a win-win situation when your patients participate in the process of receiving care.