Michael Fraley, M.D. | Health matters: Sedation options for your colonoscopy
Among people who have never had a colonoscopy, the procedure is sometimes viewed as an extremely unpleasant medical experience. Luckily, there is a team of professionals whose sole purpose is to safely make patients feel comfortable and set them at ease. This team is from the anesthesiology department.
In this column, I would like to share the options related to anesthesia for colonoscopies and ensure that you have all of the information to make a good decision for yourself. I hope that knowing that our team is there for your comfort will be a reassuring thought, as well.
First of all, it is important to know that some patients choose not to use the drugs designed to make their colonoscopy more comfortable. Not many, but some do refuse. For a variety of reasons. Since this is a personal decision, we can go forward without them and some endoscopists will, when requested.
Most low-risk patients choose moderate sedation. To achieve moderate sedation, a nurse—under the direction of an endoscopist, the doctor performing the colonoscopy—administers pain and relaxation medications intravenously, or through an IV.
The feeling is of deep relaxation. For most patients, there is very little pain or discomfort. If there is, the clinical team can adjust the medication to make you more comfortable. Most patients experience moderate sedation as if they are snoozing. For instance, if the nurse or doctor touched you on the shoulder and spoke your name, you would most likely respond by opening your eyes.
Moderate sedation protocols are designed by anesthesiologists to meet national standards. All of the nurses and doctors who administer the medications are trained by anesthesiologists and credentialed to administer moderate sedation. It is very safe.
For some patients, monitored anesthesia care (MAC) is the best option. Examples may be those who have multiple medical problems or who take a lot of medications or those who have had difficulty with moderate sedation in the past. Sometimes, a patient will choose MAC because he or she is anxious about the procedure and would like to be "completely knocked out."
Actually, MAC falls along a continuum ranging from a mild anesthetic to a general anesthetic, in which case the patient would have zero awareness after the procedure. Mild or general or at any of the many levels in between, MAC involves two care providers, an anesthesiologist and either a certified registered nurse anesthetist (CRNA) or an Anesthesiologist Assistant (AA). These two roles are similar to those of a nurse practitioner or physician assistant in a medical office.
What I like best about this model of care is the team approach. It allows the patient two sets of eyes looking specifically for anesthesia-related issues.
In advance, the team makes a plan for each MAC patient using the health history and other details provided in the referral and during preoperative assessment. Especially for high-risk patients, the anesthesiologist reviews the patient's chart thoroughly in advance.
On the day of the procedure, the anesthesiologist meets the patient in the preoperative room. The anesthesiologist will ask a lot of questions and verify all of the information provided, including the patient's name and birthdate, medical history, medications, allergies, and any adverse reactions to anesthesia in the past. There is a short physical exam. The patient is encouraged to ask any and all questions they may have.
Shortly after, the patient will meet the CRNA or AA who will be working on the team. This associate provider will also review all of the important information and examine the patient. This may seem redundant, but it is important to ensure the patient's safety. (Remember, every patient who chooses MAC gets two sets of anesthesia-trained eyes!) And again with the associate provider, the patient can get answers to all of the questions they have.
Once in the procedure room, the highly trained team follows the plan they have laid out, but they can adjust in the moment if they sense that the patient is responding differently than expected. Together, the anesthesiologist and associate provider may even adjust to the far end of the spectrum, general anesthesia.
Neither moderate sedation nor MAC have many side effects. Afterwards, some patients report feeling a touch nauseated. Both require that you wait a day before driving. The ride home you were instructed to arrange is very important. Also, it is very important to follow any other pre-procedural instructions you are given.
Some patients "come to" after the procedure asking when the procedure is going to happen. I love it when this happens. It is so fun to tell them that it's already over. They are so surprised and relieved.
The nurses, doctors, anesthesiologists, CRNAs, and AAs are all interested in making the experience painless and stress free. It gives us all great satisfaction to know that we are helping patients prevent colorectal cancer and detect it in its earliest stages, when it is most treatable. As you are riding home, I hope you will feel as many patients do: by the time you arrived at the hospital for the procedure, the hard part was already over!
Michael Fraley, M.D., is an anesthesiologist with Anesthesiology Associates of Bennington. This column was written as a part of Southwestern Vermont Medical Center's observance of Colorectal Cancer Awareness Month, which is celebrated each March. For more information about colorectal cancer screening, visit svhealthcare.org/colonscreening.
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