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Recommend anyone considering this to ask your doctor about using a sedative instead of general anesthesias. As best I can tell general anesthesia for colonosco

by graeme 6y ago

Recommend anyone considering this to ask your doctor about using a sedative instead of general anesthesias. As best I can tell general anesthesia for colonoscopy for low risk appears to be a cultural custom especially prevalent in the northeastern USA. Anesthesia has many more possible side effects than sedatives and ought to be avoided unless needed (this applies to any unneeded treatment). Plus if you’re awake you can actually watch the scope going, it’s cool! Not painful at all. Agree there is no reason to fear colonoscopy but there is also no reason to undergo general anesthesias for it either in most cases

dbcurtis 6y ago
> Plus if you’re awake you can actually watch the scope going, it’s cool! Not painful at all. For sure! My first colonoscopy I was sedated and enjoyed watching the screen. In fact, I remember I was making HILARIOUS jokes the entire time. I could not remember them afterwards though. My second colonoscopy my doctor sedated me again, but put me further under for reasons that remain a mystery. Also, a year ago we buried my brother-in-law at age 53. He was diagnosed stage 4 at age 48. DO NOT DELAY your colonoscopy. I think 50 is too late to wait.
- fortran77 6y ago
  I remember asking my doctor (I was sedated, but not 100% asleep) to look for the iPod I lost about 10 years ago.... I must admit, the experience wasn't awful. It was like getting an intestinal reset. Getting completely cleared out from the fast and prep. I felt like a new man, and very well rested after the "twilight" sedation. I only wish they could have given me a copy of the video of the procedure for my YouTube channel.
- shalmanese 6y ago
  > For sure! My first colonoscopy I was sedated and enjoyed watching the screen. In fact, I remember I was making HILARIOUS jokes the entire time. I could not remember them afterwards though. My second colonoscopy my doctor sedated me again, but put me further under for reasons that remain a mystery. It was the 15th time that week he'd heard the "rectum, damn near killed them" joke and he didn't feel he needed another aspiring comedian on the operating table.
  - taneq 6y ago
    Couldn't handle another joke about "crappy jobs". :P
- thaumasiotes 6y ago
  > In fact, I remember I was making HILARIOUS jokes the entire time. I could not remember them afterwards though. This is the primary purpose of the "sedative". I had samples taken from the interior of my stomach via a machine that went down my throat. It was an intensely unpleasant experience; you're trying to vomit for most of the time the cable is there. Anesthesia was not even recommended, but they really wanted me to take something that would inhibit memory formation. I asked if people who took the drug struggled or retched any less. "No." (I declined to take it.) This is also how women were drugged for childbirth in the mid-20th century. No anesthesia, but memory inhibitors so they couldn't remember what had happened. That was eventually "discovered" by the press and became a huge scandal. I don't get how the approach persists elsewhere.
  - Cthulhu_ 6y ago
    If I recall correctly, "general anesthesia" is actually a combination of multiple drugs with different purposes; some that inhibit memory formation, another to put you to sleep, and another to I guess relax the muscles etc?
    - rob74 6y ago
      Not sure about the drugs, but during anesthesia, you will be completely unconscious, and inhibiting memory formation is a side-effect of that. Sedation is when you are still (more or less) conscious, but relaxed. But between these two terms there are several levels: https://en.wikipedia.org/wiki/Sedation#Levels_of_sedation https://en.wikipedia.org/wiki/Sedation#Levels_of_sedation
      - thaumasiotes 6y ago
        > during anesthesia, you will be completely unconscious, and inhibiting memory formation is a side-effect of that. Sedation is when you are still (more or less) conscious, but relaxed. The concept of anesthesia is that you don't feel pain, not that you're unconscious. If you're unconscious, it's "general anesthesia"; if you're not, it's "local anesthesia".
  - 6y ago
- JKCalhoun 6y ago
  > In fact, I remember I was making HILARIOUS jokes the entire time. Jimi Hendrix remembered he was playing MUCH BETTER guitar when he was on acid. Until he heard the recordings....
- vharuck 6y ago
  >Also, a year ago we buried my brother-in-law at age 53. He was diagnosed stage 4 at age 48. DO NOT DELAY your colonoscopy. I think 50 is too late to wait. The rate of new colorectal cancer diagnoses has been increasing for those under 50 years old, despite the rate falling for the older population. I don't know if they've narrowed down a major cause. My pet theory is obesity. The usual recommendation to start screening at 50 is for asymptomatic people with no increased risk. If you have symptoms, family history of colorectal cancer, or enough other risk factors[0], bring up screening with your doctor. As somebody else mentioned, you could do fecal occult blood tests (FOBT) or other non-invasive tests if you're worried about colonoscopies. [0]https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention/risk-factors.html https://www.cancer.org/cancer/colon-rectal-cancer/causes-ris...
nerdbaggy 6y ago
While I’ve never had a colonoscopy I’ve had versed. It makes me all relaxed and forgetful. Seems like it’s the much better option that fentanyl
- dreamcompiler 6y ago
  They're different drugs. You'll definitely want the pain relief Fentanyl provides if you're getting cut open, such as for endoscopic surgery. (Fentanyl gets a bad rap because it's very dangerous as a street drug. In a healthcare setting it's a wonder drug, superior in almost every way to morphine.)
mkuklik 6y ago
I've got it done without sedatives 10 years. It was quite a ride. They went only half way and I had enough. It was literally a gut-wrenching experience.
- deepspace 6y ago
  Funny, I am considered high risk and have had it done annually for about 15 years. None of my doctors ever mentioned a sedative as an option, let alone anesthesia. And it has never been a big deal. The risk associated with anesthesia is way too high to justify it for this kind of procedure. Once every few years they find a suspicious polyp and snip it of / cauterize the wound, all with just local numbing. Still nothing worse than stubbing a toe, and certainly not worth the risk of using sedatives.
  - WWLink 6y ago
    Out here in los angeles, most doctors won't even let you in the room unless you're knocked out on propofol.
  - jeswin 6y ago
    I got mine done three years back at 36 (I've had gastric issues, and my mom has colorectal cancer) - didn't use sedatives or anesthesia. Pain tolerance is relative, so my own experience wouldn't carry over. I can understand if some people want sedatives, but anesthesia is pretty high risk like you were saying.
    - voxl 6y ago
      So much "high risk" in this thread, yet its used all over the place in United States and not a single shred of evidence to be found anywhere here...
      - Cthulhu_ 6y ago
        I did some googling; here's some studies on death rate due to anasthesia: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697561/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697561/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3147285/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3147285/ ; the latter does highlight that the incident rate has dropped a lot since the 1940's. Another one on "anesthetic awareness", or waking up during the procedure / recalling things without being able to respond, which happens 1-2 times out of 1000: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900098 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900098 "Not a single shred of evidence to be found" -> "I didn't actually look but like telling people they're wrong lol"
dehrmann 6y ago
People would be horrified what doctors will do with twilight anesthesia or even just local anesthesia.
- elric 6y ago
  How so?
cameldrv 6y ago
Second this. There is evidence that anesthesia causes brain damage. This shows up in the data most for babies and small children, and the elderly, where you can see it on IQ tests and chance of dementia. It's more pronounced with multiple surgeries. It may be that it's damaging everyone's brains, but it's just not as noticeable for adults. One study with twins showed about a 1.5 point IQ loss from a major surgery. Of course, 1.5 IQ points is not likely to dramatically change the course of your life, but I would absolutely not get it if the procedure could be done under sedation.
- dis-sys 6y ago
  It takes 10-15 minutes for a regular colonoscopy, for such short time, does the side effect of anesthesia actually comparable to the "major surgery" that can easily last 5-10 hours you mentioned?
  - hef19898 6y ago
    I always get the same stuff Michael Jackson was using. You fall deeply asleep for the duration, wake up pretty refreshed, only downside is that I am usually besides myself for the rest of the day. Good thing you aren't allowed to drive for the next 24 hours.
- JacKTrocinskI 6y ago
  Does this include the anesthesia given to us at the dentist? The one they give you in a shot to numb the tooth. I couldn't live without that.
  - therealx 6y ago
    No, that's local, not general anesthesia.
  - andi999 6y ago
    I think local anesthesia does not lead to these effects (as far as we know), I also would be surprised if it does. One thing I remember when you also use N20 (laughing gas) you should either check or just take vitamin B supplements (it seems to deplete your vitamin B storages)
deleted 6y ago
[deleted]
tonyhb 6y ago
Propofol or ketamine are both safe, low risk, and have minimal side effects when used correctly.
- meowface 6y ago
  Is propofol not a general anaesthetic? That's what I was given for my colonoscopy. Totally knocked out, and when I opened my eyes again it was all over. Side note: I was never warned about a particular effect of propofol. They started pumping it in and told me to count down from 10. At about 5, I suddenly felt this horrible searing, burning pain in my IV-connected arm that I felt spreading throughout my body. Thinking something was terribly wrong, I opened my mouth to say I'm feeling awful pain, but by then I was already falling unconscious. So I only consciously felt the pain for a few seconds, feeling totally fine (besides grogginess) when I woke up, but it was panic-inducing and some of the worst pain I've felt. Apparently it's pretty common for propofol. I think they might have told me I might feel a little discomfort, but they didn't mention the possibility of sudden, dramatic pain, for some reason. I could've grit my teeth through those seconds if I knew it was possibly going to happen, but I feared that I was having an unexpected severe allergic reaction or something, so I spent those few seconds absolutely terrified.
  - brodie 6y ago
    Propofol is definitely used as one of probably a cocktail of drugs required for various levels of sedation (AKA “general anesthesia” in this case). I’ve experienced the exact same pain you’re talking about but with IV antibiotics. No nurse or doctor could actually explain why it was happening to me, other than to say the IV had “gone bad.” Because I was in the hospital for so long, they eventually switched me to a PICC line. Absolutely zero pain with that. My own experiences with propofol involved either the PICC line, or maybe some kind of arterial line or something (I was unconscious when I was first sedated during this incident).
    - azalemeth 6y ago
      Probably local phlebitis. Propofol is a milky emulsion and is very lipid soluble (that's what makes it a good, blood-brain-barrier crossing agent!) but occasionally does cause side effects [1] --- I understand, particularly if it gets outside of the vessel at all. [1] https://www.jaci-inpractice.org/article/S2213-2198(19)30762-7/abstract https://www.jaci-inpractice.org/article/S2213-2198(19)30762-...
lemming 6y ago
This is something I've been wondering for a while, perhaps someone here knows. I've had two colonoscopies, and my understanding was that what they used was a sedative, but I was definitely totally unconscious. What's the line between sedation and general anaesthesia?
- azalemeth 6y ago
  Medically, anaesthesia is a "balanced triad" of three elements: analgesia (pain relief), narcosis (sleepiness), and muscle relaxation. It's a spectrum: we talk about having various "planes" of anaesthesia that are in principle relatively woolily defined but in practice oddly specific. An example would be the difference between a "light" form of general anaesthesia for a relatively non-invasive procedure -- such as a broncoscopy, which can be performed under heavy sedation; and something where unexpected movement can have catastrophic effects, such as surgery on the spine. It is rare, but not terribly so, for some surgical stimuli to cause local responses or motion, even when the patient is "completely under", ignoring local reflex arcs which may (or may not!) be affected by the anaesthetic agent. A good, modern anaesthetist in a western hospital has access to an incredible array of information about their patient, ranging from their complete physiological state to the partial pressures of anaesthetic gasses going into, and out of, their lungs (and thus in their blood stream). This largely means that the horror stories of the past about people "waking up and being unable to move" -- the triad becoming unbalanced and muscle relaxation ± analgesia being (barely) adequate, but narcosis clearly not -- remain in the past. I've probably waffled incoherently enough, but it's worth reiterating that anaesthesia is a _field of medicine_ in its own right. There are literally thousands of approaches, drug combinations, and "gotchas" to deal with, in all sorts of situations -- right the way from the straightforward and simple to patients with massive facial injuries where it is very difficult to know how to intubate them without causing further damage. Drug combinations are prescribed on the basis of the patient, the indication, and local rules and availability (including toxicity to the operator and cost -- many anaesthetic gasses are carcinogenic if you're exposed to them for a long period of time in trace amounts, which occasionally becomes an issue). Re: the content of this article --- if you have blood in your stool, see your doctor. (S)he won't be embarrassed about shoving a finger up your arse, and the outcomes range from "eat more fruit", or "don't have anal sex for a little while" to lifesaving surgery.
seehafer 6y ago
We badly over-use general anesthesia. Next to antibiotics it might be the most over-used thing in medicine. When you scratch the surface of the neuroscience of general anesthesia you will never want to experience it in your life if you can help it. It's effectively a controlled coma, and though we can control it, we don't know the precise mechanism of action. (Like so many things with the central nervous system it was discovered by trial-and-error.) If you're having a medical procedure and the physician mentions general anesthesia, always ask if IV sedation works as an alternative.
- marvin 6y ago
  Meanwhile, up here in Norway you have to beg and grovel and almost pretend to have a panic attack in order to get a one-off benzodiazepine-based IV sedative while taking a gastroscope down your throat. An acquaintance of mine with Down's syndrome, no less, couldn't do a gastroscopy to investigate a quality-of-life issue that was assumed to be benign, due to this. Boggles my mind, honestly. General anesthesia might be over-used, but some healthcare systems go too far in the other direction too.
  - nlitened 6y ago
    I always had issues with gastroscopy (I guess mostly panic and uncontrollable reflexes), but recently I discovered that there’s an option to do it through nose instead of mouth (of course, with a thinner tube) — highly recommend it for people like me!
    - marvin 6y ago
      I've done the nose variety. Triggered my gag reflex like there was no tomorrow. Sounds like you are different, thankfully :)
  - arcbyte 6y ago
    One of the vast number of reasons to prefer a nonsocialized Healthcare market: choice.
hardlianotion 6y ago
Very good advice. It seems that it is difficult to ensure sufficient oxygen to the brain under anaesthesia, and the effects are more noticeable in older patients.
jsmith99 6y ago
I have ulcerative colitis so have had many many colonoscopies. General anaesthetic is never used in UK but twilight sedation is normal. I refuse this as (after an unpleasant gastroscopy) I can't stand having tubes stuck up my orifices while I'm unable to fully intellectualise what's happening. They're usually happy to give a bit of fentanyl instead. My experience is that GI doctors enjoy chatting during the procedure but specialist nurses (who often perform minor endoscopies) are usually not very communicative.
- youngtaff 6y ago
  Had Fentanyl for both mine… Colonoscopy was generally OK, and it's quite interesting to see both what your insides look like, and the radar image of the path the scope takes. The prep the day before is the worst bit IMV
JacKTrocinskI 6y ago
I once had an endoscopy without any sedatives or anesthesia and that really sucked. The doc stuck a large tube down my throat and had me gagging for what felt like an eternity. After the procedure I needed a few minutes to wipe the tears that started forming from my eyes and gain some composure. This was done in Poland. If a colonoscopy is anything like that then not sure I'd want to be doing them regularly.
- hef19898 6y ago
  Edoscopies are totally different beast. Colonscopies are much easier, also on the patients. They are defenitely nothing to be afraid of.
- tinco 6y ago
  I was offered anesthesia for the endoscopy as well and I was glad I refused. The whole thing was over in 10 minutes, the actual endoscopy was about 2 minutes of serious discomfort. I gagged a couple time, the rest of the time I held steady, but the nurses also complimented me for powering through so I don't think it's expected to be easy. It was a weird and humbling experience. If you feel like you're relaxed enough to be calm when someone does something to you that your body will tell you is going to kill you, then it's not so bad. They sedate your throat to kill the gag reflex, but it doesn't work 100%. The upside for me was that it was over so quickly, and I could go on with my day, was allowed to drive, etc.
  - JacKTrocinskI 6y ago
    Yeah, I didn't have my throat sedated, that might have helped. I was able to go on with my day shortly after the procedure as well but the 5-10 minutes it lasted wasn't the most pleasant for sure.
- circlefavshape 6y ago
  My wife took no sedation when she had one, so I was shamed into doing the same when I had one a couple of years later. It was unpleasant, but not actually painful, and over quite quickly. Would opt for no sedation if I had to get it again I went for no sedation during a colonoscopy too, but after a while it got too painful and I asked for some
Starwatcher2001 6y ago
I had a colonoscopy five years ago here in the UK without any anesthesia and it was perfectly fine. Walked into the theatre wearing a gown and a pair of shorts with a flap at the back, and hopped up onto the bed. Somewhat embarrassing with a half dozen nurses standing around various bits of kit and more monitors than NASA. They asked me if I wanted to watch, then angled one of the monitors so I could see what they were doing. Laid on side, knees up and relax. Blimely is my bum really that hairy? Don't normally get to see if from that angle. It feels weird and a little uncomfortable at times, but certainly not painful - even when they found a polyp and removed it with a remote lasso tool of some kind. This later turned out to be harmless. As is normal for Brits, there was a lot of humour, with the women discussing the latest TV soap opera whilest doing their thing with the "dynorod" tool. As they pump in a gas of some kind to keep the bowl inflated while they work, they tell me it's okay to fart whenever I need. Boy, I think I've got a bad job sometimes. Whatever the nurse with the pointy end gets paid - it's not enough. It's not exactly pleasant, but necessary and quite interesting to watch inside your own body (not as interesting as watching surgeons put stents into my heart, but that's another story). Totally agree with Graeme, nothing to fear and massive win if they find things before it's too late. Don't hesitate!
- cstross 6y ago
  Same. Had one under light sedation a few years ago (switched to biannual stool screening for occult blood subsequently) and I'd say the discomfort was similar level to having a tooth filled under local anaesthesia. Not fun, occasional moments of mild discomfort, outweighed by the novelty/this is cool factor of getting to see the inside of my own guts. I will note that general anaesthesia generates lots of extra billable hours (anaesthetist! extra nurse/assistant anaesthetists!), which might be why US hospitals are so keen on it and NHS hospitals are less so.
- m463 6y ago
  I had one a few years back and it was amazingly painful. Nonetheless I would choose it over getting knocked out. This may sound like a strange sentiment, but years ago I broke a bone on a weekend and they put my arm in a sling at the emergency room. I got to see a doctor on monday and he said - you have to move your arm. "Move it every day, otherwise you will lose your range of motion. Let pain be your guide". Completely different advice than I expected (I expected to keep it immobilized as much as possible until fully healed) So I wonder if I was knocked out - would they damage something while they're looking around without my hints?
purple_ferret 6y ago
They regularly use Propofol which is not the same as general anesthesia. I've waken up (in pain) on Propofol. Pretty much impossible with a GA fluorinated gas. General Anesthesia is a very monitored situation as it's potentially very dangerous (you have to be put on a ventilator).
refurb 6y ago
Colonoscopies aren't quite general anesthesia in the US (generally, I'm sure there are exceptions). General anesthesia as being completely unresponsive to external stimuli and potentially needing supportive measures to make sure you maintain your airway. What they tend to do is "conscious sedation". Basically load you up with a sedative and painkiller - midazolam and fentanyl as an example. You're not completely out of it, you can breath on your own and will show some response to stimuli. But you won't remember any of it due to the amnesia from the sedative.
dreamcompiler 6y ago
100% agree. I've had several colonoscopies without anesthesia. This does not make me a badass (npi). It merely reflects that the fear of this procedure is completely out of proportion to the reality. It's a little bit uncomfortable in the same way that being gassy after a big meal is uncomfortable, but it's less painful than a flu shot.

by graeme 6y ago

dbcurtis 6y ago

> Plus if you’re awake you can actually watch the scope going, it’s cool! Not painful at all. For sure! My first colonoscopy I was sedated and enjoyed watching the screen. In fact, I remember I was making HILARIOUS jokes the entire time. I could not remember them afterwards though. My second colonoscopy my doctor sedated me again, but put me further under for reasons that remain a mystery. Also, a year ago we buried my brother-in-law at age 53. He was diagnosed stage 4 at age 48. DO NOT DELAY your colonoscopy. I think 50 is too late to wait.

fortran77 6y ago
I remember asking my doctor (I was sedated, but not 100% asleep) to look for the iPod I lost about 10 years ago.... I must admit, the experience wasn't awful. It was like getting an intestinal reset. Getting completely cleared out from the fast and prep. I felt like a new man, and very well rested after the "twilight" sedation. I only wish they could have given me a copy of the video of the procedure for my YouTube channel.
shalmanese 6y ago
> For sure! My first colonoscopy I was sedated and enjoyed watching the screen. In fact, I remember I was making HILARIOUS jokes the entire time. I could not remember them afterwards though. My second colonoscopy my doctor sedated me again, but put me further under for reasons that remain a mystery. It was the 15th time that week he'd heard the "rectum, damn near killed them" joke and he didn't feel he needed another aspiring comedian on the operating table.
- taneq 6y ago
  Couldn't handle another joke about "crappy jobs". :P
thaumasiotes 6y ago
> In fact, I remember I was making HILARIOUS jokes the entire time. I could not remember them afterwards though. This is the primary purpose of the "sedative". I had samples taken from the interior of my stomach via a machine that went down my throat. It was an intensely unpleasant experience; you're trying to vomit for most of the time the cable is there. Anesthesia was not even recommended, but they really wanted me to take something that would inhibit memory formation. I asked if people who took the drug struggled or retched any less. "No." (I declined to take it.) This is also how women were drugged for childbirth in the mid-20th century. No anesthesia, but memory inhibitors so they couldn't remember what had happened. That was eventually "discovered" by the press and became a huge scandal. I don't get how the approach persists elsewhere.
- Cthulhu_ 6y ago
  If I recall correctly, "general anesthesia" is actually a combination of multiple drugs with different purposes; some that inhibit memory formation, another to put you to sleep, and another to I guess relax the muscles etc?
  - rob74 6y ago
    Not sure about the drugs, but during anesthesia, you will be completely unconscious, and inhibiting memory formation is a side-effect of that. Sedation is when you are still (more or less) conscious, but relaxed. But between these two terms there are several levels: https://en.wikipedia.org/wiki/Sedation#Levels_of_sedation https://en.wikipedia.org/wiki/Sedation#Levels_of_sedation
    - thaumasiotes 6y ago
      > during anesthesia, you will be completely unconscious, and inhibiting memory formation is a side-effect of that. Sedation is when you are still (more or less) conscious, but relaxed. The concept of anesthesia is that you don't feel pain, not that you're unconscious. If you're unconscious, it's "general anesthesia"; if you're not, it's "local anesthesia".
- 6y ago
JKCalhoun 6y ago
> In fact, I remember I was making HILARIOUS jokes the entire time. Jimi Hendrix remembered he was playing MUCH BETTER guitar when he was on acid. Until he heard the recordings....
vharuck 6y ago
>Also, a year ago we buried my brother-in-law at age 53. He was diagnosed stage 4 at age 48. DO NOT DELAY your colonoscopy. I think 50 is too late to wait. The rate of new colorectal cancer diagnoses has been increasing for those under 50 years old, despite the rate falling for the older population. I don't know if they've narrowed down a major cause. My pet theory is obesity. The usual recommendation to start screening at 50 is for asymptomatic people with no increased risk. If you have symptoms, family history of colorectal cancer, or enough other risk factors[0], bring up screening with your doctor. As somebody else mentioned, you could do fecal occult blood tests (FOBT) or other non-invasive tests if you're worried about colonoscopies. [0]https://www.cancer.org/cancer/colon-rectal-cancer/causes-risks-prevention/risk-factors.html https://www.cancer.org/cancer/colon-rectal-cancer/causes-ris...

nerdbaggy 6y ago

While I’ve never had a colonoscopy I’ve had versed. It makes me all relaxed and forgetful. Seems like it’s the much better option that fentanyl

dreamcompiler 6y ago
They're different drugs. You'll definitely want the pain relief Fentanyl provides if you're getting cut open, such as for endoscopic surgery. (Fentanyl gets a bad rap because it's very dangerous as a street drug. In a healthcare setting it's a wonder drug, superior in almost every way to morphine.)

mkuklik 6y ago

I've got it done without sedatives 10 years. It was quite a ride. They went only half way and I had enough. It was literally a gut-wrenching experience.

deepspace 6y ago
Funny, I am considered high risk and have had it done annually for about 15 years. None of my doctors ever mentioned a sedative as an option, let alone anesthesia. And it has never been a big deal. The risk associated with anesthesia is way too high to justify it for this kind of procedure. Once every few years they find a suspicious polyp and snip it of / cauterize the wound, all with just local numbing. Still nothing worse than stubbing a toe, and certainly not worth the risk of using sedatives.
- WWLink 6y ago
  Out here in los angeles, most doctors won't even let you in the room unless you're knocked out on propofol.
- jeswin 6y ago
  I got mine done three years back at 36 (I've had gastric issues, and my mom has colorectal cancer) - didn't use sedatives or anesthesia. Pain tolerance is relative, so my own experience wouldn't carry over. I can understand if some people want sedatives, but anesthesia is pretty high risk like you were saying.
  - voxl 6y ago
    So much "high risk" in this thread, yet its used all over the place in United States and not a single shred of evidence to be found anywhere here...
    - Cthulhu_ 6y ago
      I did some googling; here's some studies on death rate due to anasthesia: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697561/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697561/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3147285/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3147285/ ; the latter does highlight that the incident rate has dropped a lot since the 1940's. Another one on "anesthetic awareness", or waking up during the procedure / recalling things without being able to respond, which happens 1-2 times out of 1000: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900098 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2900098 "Not a single shred of evidence to be found" -> "I didn't actually look but like telling people they're wrong lol"

dehrmann 6y ago

People would be horrified what doctors will do with twilight anesthesia or even just local anesthesia.

elric 6y ago
How so?

cameldrv 6y ago

Second this. There is evidence that anesthesia causes brain damage. This shows up in the data most for babies and small children, and the elderly, where you can see it on IQ tests and chance of dementia. It's more pronounced with multiple surgeries. It may be that it's damaging everyone's brains, but it's just not as noticeable for adults. One study with twins showed about a 1.5 point IQ loss from a major surgery. Of course, 1.5 IQ points is not likely to dramatically change the course of your life, but I would absolutely not get it if the procedure could be done under sedation.

dis-sys 6y ago
It takes 10-15 minutes for a regular colonoscopy, for such short time, does the side effect of anesthesia actually comparable to the "major surgery" that can easily last 5-10 hours you mentioned?
- hef19898 6y ago
  I always get the same stuff Michael Jackson was using. You fall deeply asleep for the duration, wake up pretty refreshed, only downside is that I am usually besides myself for the rest of the day. Good thing you aren't allowed to drive for the next 24 hours.
JacKTrocinskI 6y ago
Does this include the anesthesia given to us at the dentist? The one they give you in a shot to numb the tooth. I couldn't live without that.
- therealx 6y ago
  No, that's local, not general anesthesia.
- andi999 6y ago
  I think local anesthesia does not lead to these effects (as far as we know), I also would be surprised if it does. One thing I remember when you also use N20 (laughing gas) you should either check or just take vitamin B supplements (it seems to deplete your vitamin B storages)

deleted 6y ago

[deleted]

tonyhb 6y ago

Propofol or ketamine are both safe, low risk, and have minimal side effects when used correctly.

meowface 6y ago
Is propofol not a general anaesthetic? That's what I was given for my colonoscopy. Totally knocked out, and when I opened my eyes again it was all over. Side note: I was never warned about a particular effect of propofol. They started pumping it in and told me to count down from 10. At about 5, I suddenly felt this horrible searing, burning pain in my IV-connected arm that I felt spreading throughout my body. Thinking something was terribly wrong, I opened my mouth to say I'm feeling awful pain, but by then I was already falling unconscious. So I only consciously felt the pain for a few seconds, feeling totally fine (besides grogginess) when I woke up, but it was panic-inducing and some of the worst pain I've felt. Apparently it's pretty common for propofol. I think they might have told me I might feel a little discomfort, but they didn't mention the possibility of sudden, dramatic pain, for some reason. I could've grit my teeth through those seconds if I knew it was possibly going to happen, but I feared that I was having an unexpected severe allergic reaction or something, so I spent those few seconds absolutely terrified.
- brodie 6y ago
  Propofol is definitely used as one of probably a cocktail of drugs required for various levels of sedation (AKA “general anesthesia” in this case). I’ve experienced the exact same pain you’re talking about but with IV antibiotics. No nurse or doctor could actually explain why it was happening to me, other than to say the IV had “gone bad.” Because I was in the hospital for so long, they eventually switched me to a PICC line. Absolutely zero pain with that. My own experiences with propofol involved either the PICC line, or maybe some kind of arterial line or something (I was unconscious when I was first sedated during this incident).
  - azalemeth 6y ago
    Probably local phlebitis. Propofol is a milky emulsion and is very lipid soluble (that's what makes it a good, blood-brain-barrier crossing agent!) but occasionally does cause side effects [1] --- I understand, particularly if it gets outside of the vessel at all. [1] https://www.jaci-inpractice.org/article/S2213-2198(19)30762-7/abstract https://www.jaci-inpractice.org/article/S2213-2198(19)30762-...

lemming 6y ago

This is something I've been wondering for a while, perhaps someone here knows. I've had two colonoscopies, and my understanding was that what they used was a sedative, but I was definitely totally unconscious. What's the line between sedation and general anaesthesia?

azalemeth 6y ago
Medically, anaesthesia is a "balanced triad" of three elements: analgesia (pain relief), narcosis (sleepiness), and muscle relaxation. It's a spectrum: we talk about having various "planes" of anaesthesia that are in principle relatively woolily defined but in practice oddly specific. An example would be the difference between a "light" form of general anaesthesia for a relatively non-invasive procedure -- such as a broncoscopy, which can be performed under heavy sedation; and something where unexpected movement can have catastrophic effects, such as surgery on the spine. It is rare, but not terribly so, for some surgical stimuli to cause local responses or motion, even when the patient is "completely under", ignoring local reflex arcs which may (or may not!) be affected by the anaesthetic agent. A good, modern anaesthetist in a western hospital has access to an incredible array of information about their patient, ranging from their complete physiological state to the partial pressures of anaesthetic gasses going into, and out of, their lungs (and thus in their blood stream). This largely means that the horror stories of the past about people "waking up and being unable to move" -- the triad becoming unbalanced and muscle relaxation ± analgesia being (barely) adequate, but narcosis clearly not -- remain in the past. I've probably waffled incoherently enough, but it's worth reiterating that anaesthesia is a _field of medicine_ in its own right. There are literally thousands of approaches, drug combinations, and "gotchas" to deal with, in all sorts of situations -- right the way from the straightforward and simple to patients with massive facial injuries where it is very difficult to know how to intubate them without causing further damage. Drug combinations are prescribed on the basis of the patient, the indication, and local rules and availability (including toxicity to the operator and cost -- many anaesthetic gasses are carcinogenic if you're exposed to them for a long period of time in trace amounts, which occasionally becomes an issue). Re: the content of this article --- if you have blood in your stool, see your doctor. (S)he won't be embarrassed about shoving a finger up your arse, and the outcomes range from "eat more fruit", or "don't have anal sex for a little while" to lifesaving surgery.

seehafer 6y ago

We badly over-use general anesthesia. Next to antibiotics it might be the most over-used thing in medicine. When you scratch the surface of the neuroscience of general anesthesia you will never want to experience it in your life if you can help it. It's effectively a controlled coma, and though we can control it, we don't know the precise mechanism of action. (Like so many things with the central nervous system it was discovered by trial-and-error.) If you're having a medical procedure and the physician mentions general anesthesia, always ask if IV sedation works as an alternative.

marvin 6y ago
Meanwhile, up here in Norway you have to beg and grovel and almost pretend to have a panic attack in order to get a one-off benzodiazepine-based IV sedative while taking a gastroscope down your throat. An acquaintance of mine with Down's syndrome, no less, couldn't do a gastroscopy to investigate a quality-of-life issue that was assumed to be benign, due to this. Boggles my mind, honestly. General anesthesia might be over-used, but some healthcare systems go too far in the other direction too.
- nlitened 6y ago
  I always had issues with gastroscopy (I guess mostly panic and uncontrollable reflexes), but recently I discovered that there’s an option to do it through nose instead of mouth (of course, with a thinner tube) — highly recommend it for people like me!
  - marvin 6y ago
    I've done the nose variety. Triggered my gag reflex like there was no tomorrow. Sounds like you are different, thankfully :)
- arcbyte 6y ago
  One of the vast number of reasons to prefer a nonsocialized Healthcare market: choice.

hardlianotion 6y ago

Very good advice. It seems that it is difficult to ensure sufficient oxygen to the brain under anaesthesia, and the effects are more noticeable in older patients.

jsmith99 6y ago

I have ulcerative colitis so have had many many colonoscopies. General anaesthetic is never used in UK but twilight sedation is normal. I refuse this as (after an unpleasant gastroscopy) I can't stand having tubes stuck up my orifices while I'm unable to fully intellectualise what's happening. They're usually happy to give a bit of fentanyl instead. My experience is that GI doctors enjoy chatting during the procedure but specialist nurses (who often perform minor endoscopies) are usually not very communicative.

youngtaff 6y ago
Had Fentanyl for both mine… Colonoscopy was generally OK, and it's quite interesting to see both what your insides look like, and the radar image of the path the scope takes. The prep the day before is the worst bit IMV

JacKTrocinskI 6y ago

I once had an endoscopy without any sedatives or anesthesia and that really sucked. The doc stuck a large tube down my throat and had me gagging for what felt like an eternity. After the procedure I needed a few minutes to wipe the tears that started forming from my eyes and gain some composure. This was done in Poland. If a colonoscopy is anything like that then not sure I'd want to be doing them regularly.

hef19898 6y ago
Edoscopies are totally different beast. Colonscopies are much easier, also on the patients. They are defenitely nothing to be afraid of.
tinco 6y ago
I was offered anesthesia for the endoscopy as well and I was glad I refused. The whole thing was over in 10 minutes, the actual endoscopy was about 2 minutes of serious discomfort. I gagged a couple time, the rest of the time I held steady, but the nurses also complimented me for powering through so I don't think it's expected to be easy. It was a weird and humbling experience. If you feel like you're relaxed enough to be calm when someone does something to you that your body will tell you is going to kill you, then it's not so bad. They sedate your throat to kill the gag reflex, but it doesn't work 100%. The upside for me was that it was over so quickly, and I could go on with my day, was allowed to drive, etc.
- JacKTrocinskI 6y ago
  Yeah, I didn't have my throat sedated, that might have helped. I was able to go on with my day shortly after the procedure as well but the 5-10 minutes it lasted wasn't the most pleasant for sure.
circlefavshape 6y ago
My wife took no sedation when she had one, so I was shamed into doing the same when I had one a couple of years later. It was unpleasant, but not actually painful, and over quite quickly. Would opt for no sedation if I had to get it again I went for no sedation during a colonoscopy too, but after a while it got too painful and I asked for some

Starwatcher2001 6y ago

I had a colonoscopy five years ago here in the UK without any anesthesia and it was perfectly fine. Walked into the theatre wearing a gown and a pair of shorts with a flap at the back, and hopped up onto the bed. Somewhat embarrassing with a half dozen nurses standing around various bits of kit and more monitors than NASA. They asked me if I wanted to watch, then angled one of the monitors so I could see what they were doing. Laid on side, knees up and relax. Blimely is my bum really that hairy? Don't normally get to see if from that angle. It feels weird and a little uncomfortable at times, but certainly not painful - even when they found a polyp and removed it with a remote lasso tool of some kind. This later turned out to be harmless. As is normal for Brits, there was a lot of humour, with the women discussing the latest TV soap opera whilest doing their thing with the "dynorod" tool. As they pump in a gas of some kind to keep the bowl inflated while they work, they tell me it's okay to fart whenever I need. Boy, I think I've got a bad job sometimes. Whatever the nurse with the pointy end gets paid - it's not enough. It's not exactly pleasant, but necessary and quite interesting to watch inside your own body (not as interesting as watching surgeons put stents into my heart, but that's another story). Totally agree with Graeme, nothing to fear and massive win if they find things before it's too late. Don't hesitate!

cstross 6y ago
Same. Had one under light sedation a few years ago (switched to biannual stool screening for occult blood subsequently) and I'd say the discomfort was similar level to having a tooth filled under local anaesthesia. Not fun, occasional moments of mild discomfort, outweighed by the novelty/this is cool factor of getting to see the inside of my own guts. I will note that general anaesthesia generates lots of extra billable hours (anaesthetist! extra nurse/assistant anaesthetists!), which might be why US hospitals are so keen on it and NHS hospitals are less so.
m463 6y ago
I had one a few years back and it was amazingly painful. Nonetheless I would choose it over getting knocked out. This may sound like a strange sentiment, but years ago I broke a bone on a weekend and they put my arm in a sling at the emergency room. I got to see a doctor on monday and he said - you have to move your arm. "Move it every day, otherwise you will lose your range of motion. Let pain be your guide". Completely different advice than I expected (I expected to keep it immobilized as much as possible until fully healed) So I wonder if I was knocked out - would they damage something while they're looking around without my hints?

purple_ferret 6y ago

They regularly use Propofol which is not the same as general anesthesia. I've waken up (in pain) on Propofol. Pretty much impossible with a GA fluorinated gas. General Anesthesia is a very monitored situation as it's potentially very dangerous (you have to be put on a ventilator).

refurb 6y ago

Colonoscopies aren't quite general anesthesia in the US (generally, I'm sure there are exceptions). General anesthesia as being completely unresponsive to external stimuli and potentially needing supportive measures to make sure you maintain your airway. What they tend to do is "conscious sedation". Basically load you up with a sedative and painkiller - midazolam and fentanyl as an example. You're not completely out of it, you can breath on your own and will show some response to stimuli. But you won't remember any of it due to the amnesia from the sedative.

dreamcompiler 6y ago

100% agree. I've had several colonoscopies without anesthesia. This does not make me a badass (npi). It merely reflects that the fear of this procedure is completely out of proportion to the reality. It's a little bit uncomfortable in the same way that being gassy after a big meal is uncomfortable, but it's less painful than a flu shot.