Colonoscopy Sedation Options

A colonoscopy screens for, diagnoses and treats problems in the large bowel and in the end, or the terminal ileum, of the small bowel. During this medical procedure, a long, flexible endoscope, or telescope, is passed through the rectum and through the large bowel. Air can be blown into the endoscope so folds in the intestine can be studied. Tiny forceps can also be passed through the endoscope so small tissue samples can be taken and biopsied. The entire procedure takes about 10 to 20 minutes if no problems are encountered. More time may be needed if polyps, small growths or strictures, narrowings in the intestine, are found. The primary concern during the procedure is the patient's comfort and thus different forms of sedation are used.

Conscious Sedation

Intravenous sedatives cause conscious sedation. The patient becomes relaxed and sleepy but is still able to follow any instructions given by the doctor. After the procedure, the patient is kept in the hospital for at least one hour, and a friend or family member takes the patient home.

Dosage

Intravenous benzodiazepines also are used as a form of sedation. The two most common forms are midazolam at a dose of 2-5 mg and diazepam at 5-10 mg. Fentanyl is administered at between 50 and 100 mg. Meperidine (Demerol) at 25-100 mg may be added.

Alternative Medications

Propofol, a sedative, is an alternate agent that can be used. Alfentanil, supentanil and remifentanil, all painkillers, are similar to fentanyl.

Side Effects

The drugs administered for anesthesia and sedation have serious side effects, so the patient must be closely monitored during the procedure. These side effects include labored or suppression of breathing and nausea.

Benefits

During deep sedation, polyps as well as any other potential problems can be more easily discovered. Cancer detection is higher when the patient has been deeply sedated because colonoscopists are not distracted by patient discomfort or anxiety; hence, doctors can concentrate on the procedure.

No Sedation

Colonoscopies without sedation are common in Asia and Europe and could become more widely used in the United States. The risks are minimal and the benefits include understanding the doctor's instructions and the doctor's conversation as the doctor is performing the procedure.

Tags: during procedure, large bowel, passed through, procedure patient