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Anesthesia

Colonoscopy with only painkiller?

08/07/2006

Question:

Is it possible to have a colonoscopy with a painkiller but no added sedative? I truly hate the experience of IV sedation--for the same reason that I hate drinking to intoxication and then dealing with the hangover. I also like to remember my experiences. (I had to consult 5 cataract surgeons before I found one who would let me skip the Versed, but it was worth the effort. The surgery was painless with topical anesthesia and I felt fine afterwards, and I didn`t need to spend the rest of the day recovering from sedatives.)

Answer:

There are many possible combinations of drugs that are used to sedate patients undergoing colonoscopy. A typical combination is midazolam (Versed), which is a sedative, and fentanyl, a painkiller. Another approach is to use a sedative/anesthetic agent called propofol. Cataract operations are quite easily done without sedation because with modern surgical techniques there is little to no pain when topical anesthetic drops or a nerve block are used.

Topical anesthesia is obviously not an option for a colonoscopy, so the intravenous drugs administered are more important. I believe it is possible to have a colonoscopy with painkiller only and no sedation. It might be a less comfortable experience. You might be given fentanyl, or similar drug only. You need to discuss this with the anesthesia provider. I suggest that you not limit the anesthesiologists options during the procedure. In other words you might start with the approach you are describing but allow the anesthesiologist to administer other drugs, including sedatives, if things don't go as well as planned with painkillers only.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University