Side effects of propofol for colonoscopy. Propofol for Colonoscopy: Side Effects, Warnings, and Uses

23.08.201918.04.2021 by alexxlab

What are the side effects of propofol for colonoscopy. How is propofol used during a colonoscopy procedure. What precautions should be taken when using propofol. When is propofol contraindicated for colonoscopy.

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Understanding Propofol and Its Role in Colonoscopy

Propofol, also known by its brand name Diprivan, is a short-acting intravenous anesthetic agent commonly used for sedation during colonoscopy procedures. Its rapid onset and quick recovery time make it an attractive option for outpatient procedures like colonoscopies.

How does propofol work during a colonoscopy? Propofol acts on the central nervous system to induce a state of unconsciousness, allowing patients to remain comfortable and still during the procedure. The drug is administered intravenously by an anesthesiologist or trained healthcare professional who monitors the patient’s vital signs throughout the colonoscopy.

Benefits of Propofol for Colonoscopy

Rapid onset of action (typically within 40 seconds)
Short duration of effect, allowing for quick recovery
Minimal residual drowsiness after the procedure
Reduced risk of nausea and vomiting compared to other sedatives
Improved patient comfort and compliance during the colonoscopy

Common Side Effects of Propofol During Colonoscopy

While propofol is generally considered safe for use in colonoscopy procedures, it can cause several side effects. Are the side effects of propofol serious? Most side effects are mild and short-lived, but some can be more severe and require medical attention.

Mild Side Effects

Pain or discomfort at the injection site
Temporary changes in blood pressure and heart rate
Slight confusion or disorientation upon waking
Headache
Dizziness
Nausea (less common than with other sedatives)

More Serious Side Effects

While rare, some patients may experience more severe side effects from propofol during a colonoscopy. These can include:

Allergic reactions (rash, itching, swelling)
Difficulty breathing or wheezing
Irregular heartbeat
Seizures
Prolonged unconsciousness

Can propofol cause long-term side effects after a colonoscopy? Generally, the effects of propofol wear off quickly, and long-term side effects are rare. However, some patients may experience lingering drowsiness or confusion for a few hours after the procedure.

Precautions and Warnings for Propofol Use in Colonoscopy

Before undergoing a colonoscopy with propofol sedation, it’s crucial to inform your healthcare provider about your medical history and any medications you’re currently taking. Certain conditions and medications may increase the risk of complications or require dosage adjustments.

Medical Conditions to Disclose

Allergies to eggs, soy, or other medications
Heart problems or high blood pressure
Liver or kidney disease
Seizure disorders
Sleep apnea or other breathing disorders
History of adverse reactions to anesthesia

Is propofol safe for patients with allergies? Patients with allergies to eggs, soybeans, or sulfites should inform their doctor, as propofol contains these ingredients and may cause allergic reactions in sensitive individuals.

Medication Interactions

Certain medications can interact with propofol, potentially increasing the risk of side effects or altering its effectiveness. These include:

Blood thinners (e.g., warfarin, heparin)
Benzodiazepines (e.g., diazepam, lorazepam)
Opioid pain medications
Some antidepressants and antipsychotics
Certain antibiotics

Always provide your healthcare team with a complete list of all medications, including over-the-counter drugs and supplements, to ensure safe administration of propofol during your colonoscopy.

Contraindications for Propofol Use in Colonoscopy

While propofol is widely used and generally safe, there are situations where its use may be contraindicated or require special consideration.

Absolute Contraindications

Known allergy to propofol or its components (eggs, soy, sulfites)
Severe untreated hypovolemia
Pregnancy (unless absolutely necessary)

Relative Contraindications

In these cases, the use of propofol should be carefully evaluated and monitored:

Elderly patients (may require lower doses)
Patients with severe cardiac or respiratory disease
Individuals with a history of seizures
Patients with compromised liver or kidney function

Can pregnant women undergo colonoscopy with propofol sedation? Propofol is generally avoided during pregnancy unless the potential benefits outweigh the risks. Alternative sedation methods may be considered for pregnant patients requiring colonoscopy.

Preparing for a Colonoscopy with Propofol Sedation

Proper preparation is essential for a safe and effective colonoscopy, especially when propofol sedation is used. Following your doctor’s instructions carefully can help minimize risks and ensure the best possible outcome.

Pre-Procedure Instructions

Fasting: Typically, you’ll be asked to avoid solid foods for at least 8 hours before the procedure and clear liquids for 2-4 hours prior.
Medication adjustments: Your doctor may advise you to stop or adjust certain medications before the colonoscopy.
Arrange transportation: Due to the sedative effects of propofol, you will not be able to drive after the procedure. Arrange for someone to take you home.
Inform your doctor about any recent illnesses or changes in your health status.
Remove jewelry, contact lenses, and dentures before the procedure.

How long does it take to recover from propofol sedation after a colonoscopy? Most patients feel alert and oriented within 30-60 minutes after the procedure. However, it’s recommended to avoid driving, operating machinery, or making important decisions for at least 24 hours after receiving propofol.

Monitoring and Recovery After Propofol Sedation

After your colonoscopy with propofol sedation, you’ll be closely monitored in a recovery area until the effects of the medication wear off. This typically involves:

Continuous monitoring of vital signs (heart rate, blood pressure, oxygen levels)
Assessment of alertness and orientation
Evaluation for any immediate side effects or complications

Once you’re fully awake and stable, you’ll be given discharge instructions and allowed to go home with your designated driver. It’s normal to feel groggy or slightly disoriented for a few hours after the procedure.

Post-Procedure Care

To ensure a smooth recovery after propofol sedation for colonoscopy:

Rest for the remainder of the day
Gradually resume your normal diet as tolerated
Stay hydrated by drinking plenty of fluids
Avoid alcohol for at least 24 hours
Refrain from signing legal documents or making important decisions for 24 hours
Follow up with your doctor as instructed

When should you seek medical attention after a colonoscopy with propofol? Contact your healthcare provider immediately if you experience severe abdominal pain, persistent bleeding, fever, or signs of an allergic reaction in the hours or days following your procedure.

Alternatives to Propofol for Colonoscopy Sedation

While propofol is a popular choice for colonoscopy sedation, it’s not the only option available. Depending on your individual needs and medical history, your doctor may recommend alternative sedation methods.

Common Alternatives to Propofol

Midazolam (Versed): A benzodiazepine that provides sedation and anxiety relief
Fentanyl: An opioid pain medication often used in combination with midazolam
Meperidine (Demerol): Another opioid option for pain control during colonoscopy
Nitrous oxide: Inhaled gas that provides mild sedation and pain relief
Conscious sedation: A combination of medications that allow the patient to remain awake but relaxed

Are there non-sedation options for colonoscopy? Some patients may opt for a colonoscopy without sedation, using only local anesthesia. This approach is less common but may be suitable for certain individuals who prefer to remain fully alert during the procedure.

Factors Influencing Sedation Choice

The decision to use propofol or an alternative sedation method for colonoscopy depends on various factors, including:

Patient preferences and anxiety levels
Medical history and current health status
Previous experiences with sedation or anesthesia
Anticipated complexity of the procedure
Availability of anesthesia providers
Cost considerations and insurance coverage

Discuss your options with your healthcare provider to determine the most appropriate sedation method for your colonoscopy.

Conclusion

Propofol has revolutionized sedation for colonoscopy procedures, offering rapid onset, quick recovery, and improved patient comfort. While it is generally safe and effective, understanding the potential side effects, precautions, and alternatives is crucial for making informed decisions about your healthcare.

By following your doctor’s instructions, disclosing your complete medical history, and communicating any concerns, you can help ensure a safe and successful colonoscopy experience with propofol sedation. Remember that every patient is unique, and your healthcare team will work with you to determine the best approach for your individual needs.

As medical knowledge and practices continue to evolve, staying informed about sedation options for colonoscopy can help you actively participate in your healthcare decisions and achieve the best possible outcomes.

Side Effects of Propofol (Propofol Injectable Emulsion), Warnings, Uses

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Puget Sound GastroenterologyPuget Sound Gastroenterology

Your physician has determined that an examination of your colon is necessary to further evaluate or treat your symptoms. This information has been prepared to answer questions our patients most frequently ask.

What is a colonoscopy?
What preparation is necessary?
Are there any side effects, pain or discomfort associated with a colonoscopy?
What can I expect when I arrive at the endoscopy center?
What can I expect during the colonoscopy?
What are the possible complications of a colonoscopy?
Why is an anesthesiologist involved in a colonoscopy?
What is Propofol, Versed, and Fentanyl?

What is a colonoscopy?

A colonoscopy is an exam using an instrument called a colonoscope. The colonoscope is a thin, lighted flexible tube. This instrument allows the physician to directly view the inside of your colon (large intestine). Photos and tissue samples (biopsies) may be taken to document findings. This is a painless way for your physician to evaluate the colon in great detail.

Polyps are small growths originating in the lining of the colon. Most polyps are benign (noncancerous), but the physician cannot always tell a benign polyp from a malignant (cancerous) polyp by its visual appearance. For this reason, all polyps found will be removed and sent to a pathologist for analysis. You should feel no discomfort during the polyp removal. Removal of colon polyps is important in preventing colorectal cancer.

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What preparation is necessary?

Your colon must be clean in order for your physician to view the lining of the colon. A special diet followed by a laxative preparation is necessary to clear out any waste or solid residue. These instructions must be followed exactly. Any solid material retained in the large intestine may prolong the procedure or make it necessary to repeat the examination at another time. See preparation instructions.

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Are there any side effects, pain or discomfort associated with a colonoscopy?

PSG uses several different sedation medications that are dependent on personal health, procedure, and other factors. The most common sedation medication that we utilize is known as Propofol, however your physician/anesthetist may decide to use another method of “conscious sedation” during your procedure, such as Fentanyl or Versed. If you have further questions about the type of sedation you will receive, your physician will have more information. Your physician will also put air into your colon to help visualize the lining and this sometimes causes a cramping or bloated sensation. (Passing this air during and following the exam will relieve any discomfort.) Once you pass this air/gas, you will feel more comfortable.

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What can I expect when I arrive at the endoscopy center?

When you arrive at the endoscopy center, you will be asked to change into a gown. The nurse will ask you questions about your medical history and current medication use. Updating this information will make the procedure safe for you. Please be prepared to review your health history at this time. Bring a list of medications and drug allergies, if necessary. Your blood pressure, pulse rate, and oxygen saturation will be monitored before, during and after the exam. An intravenous (IV) needle will be placed in your hand or arm.

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What can I expect during the colonoscopy?

The nurse/endoscopy technician will help you get comfortable on a stretcher. After blood pressure and heart rate monitors are applied, you will lie on your left side. Your physician, anesthetist or nurse will give you an intravenous injection of medication. After you become relaxed, the physician will insert the tip of the scope into your rectum and advance it forward into the colon. The procedure takes 20-45 minutes. When your exam is finished, you will be taken to the recovery room for observation. The sedation used during your exam impairs judgment, memory, and equilibrium for about 12 hours. You cannot drive or operate any mechanical equipment for 12 hours, and should avoid alcohol and/or tranquilizers during this time. Except for these restrictions, you may resume your normal diet unless directed otherwise by your physician. Normal activities such as signing legal documents or exercise can be resumed the following day. We cannot perform this procedure unless we know that you will arrive home safely, so please bring a friend or family member with you.

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What are the possible complications of colonoscopy?

When performed by a knowledgeable and competent physician, a colonoscopy is a very low-risk procedure. Very rarely, bleeding or perforation (tearing of the lining of the colon) may occur. Other risks include a reaction to medication, irritation at the site of the injection, or complications related to other medical problems that you may already have. Although complications after colonoscopy are uncommon, it is important for you to recognize early signs of any possible complication. Contact your physician if you notice any of the following symptoms: severe abdominal pain, fever and chills, or rectal bleeding even several days following a polyp removal.

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Why is an anesthesiologist involved in a colonoscopy?

Only anesthesiologists or nurse anesthetists are licensed to administer Propofol, which is the medication administered during the colonoscopy. Our board-certified anesthesiologists are fully trained and experienced in administering Propofol.

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What is Propofol, Versed, and Fentanyl ?

Propofol is a safe and effective medication that is being used with increasing frequency for endoscopic procedures, such as colonoscopy. Though all sedation methods that PSG provides allow you to be fully anesthetized for your procedure, Propofol offers a quicker recovery and may be preferred for use by your physician. Your provider may also choose to use Versed and Fentanyl to provide you with a “conscious sedation” for your procedure. These medications will allow you to be awake during your procedure, but will allow you a pain and discomfort free experience.

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Propofol: Uses, Dosage, Side Effects & Warnings

Generic Name: propofol (PROE poe fol)
Brand Name: Diprivan, Propoven

Medically reviewed by Kaci Durbin, MD. Last updated on Feb 2, 2021.

What is propofol?

Propofol (Diprivan) slows the activity of your brain and nervous system.

Propofol is used to put you to sleep and keep you asleep during general anesthesia for surgery or other medical procedures. It is used in adults as well as children 2 months and older.

Propofol is also used to sedate a patient who is under critical care and needs a mechanical ventilator (breathing machine).

Warnings

Before you receive propofol, tell your doctor about all your medical conditions and allergies. Also make sure your doctor knows if you are pregnant or breast-feeding. In some cases, you may not be able to use propofol.

The FDA cautions recommends against using propofol if you are allergic to eggs, egg products, soybeans, or soy products.

Before receiving this medicine

You should not receive propofol if you are allergic to it. Tell your doctor if you have allergies to eggs, egg products, soybeans, or soy products.

To make sure this medicine is safe for you, tell your doctor if you have:

Anesthesia medicine may affect brain development in a child under 3, or an unborn baby whose mother receives this medicine during late pregnancy. These effects may be more likely when the anesthesia is used for 3 hours or longer, or used for repeated procedures. Effects on brain development could cause learning or behavior problems later in life.

Negative brain effects from anesthesia have been seen in animal studies. However, studies in human children receiving single short uses of anesthesia have not shown a likely effect on behavior or learning. More research is needed.

In some cases, your doctor may decide to postpone a surgery or procedure based on these risks. Treatment may not be delayed in the case of life-threatening conditions, medical emergencies, or surgery needed to correct certain birth defects.

Ask your doctor for information about all medicines that will be used during your surgery or procedure. Also ask how long the procedure will last.

Propofol can pass into breast milk and may harm a nursing baby. However, as propofol acts and leaves the body quickly, most women can resume breastfeeding as soon as they are recovered from anesthesia and fully awake.

How is propofol given?

Propofol is injected into a vein through an IV. A healthcare provider will give you this injection.

You will relax and fall asleep very quickly after propofol is injected.

Your breathing, blood pressure, oxygen levels, kidney function, and other vital signs will be watched closely while you are under the effects of propofol.

What happens if I miss a dose?

Since propofol is given by a healthcare professional in a medical setting, you are not likely to miss a dose.

What happens if I overdose?

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

What should I avoid after receiving propofol?

Propofol causes severe drowsiness and dizziness, which may last for several hours. You will need someone to drive you home after your surgery or procedure. Do not drive yourself or do anything that requires you to be awake and alert for at least 24 hours after you have been treated with propofol.

Propofol side effects

Get emergency medical help if you have any signs of an allergic reaction to propofol: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Long-term use of propofol can lead to a syndrome called Propfol Infusion Syndrome, which may result in death.

Tell your caregiver right away if you have:

a light-headed feeling (like you might pass out) even after feeling awake;
weak or shallow breathing; or
severe pain or discomfort where the injection is given.

Common propofol side effects may include:

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect propofol?

Taking other medicines that make you sleepy or slow your breathing can worsen these effects. After you have been treated with propofol, ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures (especially valproic acid).

Other drugs may interact with this medicine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

More about propofol

Consumer resources

Other brands: Diprivan

Professional resources

Related treatment guides

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Propofol (Intravenous Route) Side Effects

Side Effects

Drug information provided by: IBM Micromedex

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

More common

Blurred vision

confusion

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

fast, slow, irregular, or pounding heartbeat or pulse

headache

nervousness

pounding in the ears

problems with movement

sweating

unusual tiredness or weakness

Less common

Bluish lips or skin

chest pain or discomfort

difficulty breathing

lightheadedness, dizziness, or fainting

Rare

Anxiety

bleeding gums

burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings

changes in vision

chills

cloudy urine

cough

coughing up blood

delirium or hallucinations

difficult urination

difficulty swallowing

dry eyes, mouth, nose, or throat

excessive muscle tone

eye pain

fever

flushing or redness of the face

general feeling of illness

hives, itching, skin rash

inability to move the eyes

increased blinking or spasms of the eyelid

increased menstrual flow or vaginal bleeding

increased watering of the mouth

irritability

joint pain or swelling

loss of appetite

mood or mental changes

muscle aches, cramps, or pains

muscle spasms or twitching

muscle stiffness, tension, or tightness

nausea or vomiting

nosebleeds

pain in the arms or legs

prolonged bleeding from cuts

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

red or dark brown urine

red or black, tarry stools

restlessness

shaking

sleepiness or unusual drowsiness

sore throat

sticking out of tongue

tightness in the chest

trembling

trouble sleeping

trouble speaking

uncontrolled twisting movements of the neck, trunk, arms, or legs

unusual facial expressions

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Portions of this document last updated: April 01, 2021

Big Sleep: Beyond Propofol Sedation During GI Endoscopy

In the USA, endoscopic procedures are usually performed on sedated patients, which improves overall patient acceptance and comfort while improving procedural safety, efficiency, and quality [1]. A range of sedation depth is available, from moderate sedation on the one hand to general anesthesia on the other. Although during general anesthesia patients are not arousable even by painful stimulation, moderate sedation (“conscious sedation”) is characterized by depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. At least in the USA, deep sedation is preferred by both patients and their gastroenterologists.

The American Society of Anesthesiology defines deep sedation as a drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation. Since during sedation the patient’s ability to independently maintain ventilatory function may be impaired, they may thus require assistance in maintaining a patent airway; furthermore, spontaneous ventilation is likely to be inadequate although cardiovascular function is usually maintained [2]. Often, the state of deep sedation slips into general anesthesia, including deep general anesthesia, especially when sedatives are administered by anesthesia providers [3].

Propofol is regarded as the sine qua non agent for gastroenterological endoscopic sedation. In spite of many publications highlighting the dangers of propofol sedation in patients undergoing endoscopic procedures, it remains the most popular sedative agent in North America for endoscopic sedation. Some of the major attractions of propofol sedation are rapid onset of action, rapid recovery, low incidence of post-procedure nausea and vomiting, and high degree of patient satisfaction. The safety record is mixed depending on the person administering the propofol and the dose administered. Both apnea and laryngospasm may occur which will not be discussed further. Aspiration is another known risk factor, largely related to suppression of laryngeal reflex. Moreover, colonic perforation occurs with higher frequency in patients undergoing colonoscopy with propofol deep sedation. While such sedation-related adverse events are typically frequent when propofol was administered by anesthesia providers, they are significantly lower in the hands of non-anesthesia providers [4, 5] most likely since anesthesia providers administer higher doses of propofol than do non-anesthesia providers [6]. The same observation explains the observed superior patient and endoscopist satisfaction in the groups of patients where anesthesia providers administered propofol. A remarkable degree of patient and endoscopist satisfaction is at the core of propofol success story.

Almost every agent capable of producing deep sedation has been tried in patients undergoing GI endoscopy. Etomidate was invented and approved for clinical use few years earlier than propofol, with an unparalleled degree of cardiovascular stability as its major attraction and the selling point. Adrenal suppression, especially in critically ill patients, is its main drawback since it exhibits a dose-dependent inhibition of adrenal mitochondrial 11-β hydroxylase, the enzyme responsible for the final conversion of 11-deoxycortisol to cortisol. Although adrenal suppression was touted as a problem in only sick patients receiving a continuous infusion, it is also observed with induction doses. This adverse effect was considered responsible for the increased mortality associated with etomidate and is considered to be specifically detrimental in septic patients who may have a baseline adrenal insufficiency due to critical illness [7]. Nevertheless, patients with poor cardiovascular reserve (and not septic) are frequently endoscoped as inpatients or as outpatients, including patients with a low ejection fraction, biventricular pacemaker implantation, and other serious cardiac comorbidities. As an example of the need for sedated procedures performed in patients with serious cardiac morbidity, colonoscopy is often performed, frequently on an outpatient basis, prior to cardiac transplantation.

In a prospective double-blinded randomized controlled trial comparing etomidate and propofol sedation for complex upper endoscopic procedures, Kim et al. [8] reported fewer respiratory depression events and superior sedative efficacy for etomidate compared with propofol. Thus far, there have been no comparative studies of patient and endoscopist satisfaction in patients undergoing gastro-intestinal (GI) endoscopy. In this issue of Digestive Diseases and Sciences, Lee et al. published the results of their findings in relation to patient satisfaction among patients undergoing advanced endoscopic procedures [9]. In this randomized non-inferiority trial, balanced endoscopic sedation was achieved using midazolam and fentanyl, followed by either propofol or etomidate as an add-on drug in a randomized fashion. The doses of both propofol and etomidate were tailored to achieve moderate, but not deep sedation. As expected, the incidence of cardiopulmonary adverse events (including respiratory and cardiovascular) were lower in the etomidate group. Moreover, the incidence of adverse respiratory events such as hypoxia was lower with etomidate. Three patients receiving etomidate experienced rigidity or tremor after sedation. Most importantly, satisfaction of endoscopists and nurses and patient’s cooperation in the etomidate group was non-inferior when compared to the propofol group. In essence, where appropriate, etomidate may be used to provide appropriate levels of sedation to successfully complete advanced endoscopic procedures with a degree of satisfaction similar to propofol. Given the limited experience with etomidate in patients undergoing GI endoscopy, these findings are important and should encourage providers to use this drug where appropriate such as in candidates that have limited cardiovascular reserve in the absence of sepsis, where propofol may be undesirable. Nonetheless, one might circumvent the cardiovascular adverse events associated with propofol by preemptive administration of inotropes and/or vasopressors.

Other than etomidate, several other anesthetics have seen little use as sedatives for GI procedures. Ketamine is another agent capable of producing deep sedation, though inadequately explored in the setting of GI endoscopy [10]. Its range of effects includes analgesia, amnesia, anesthesia, and sedation. Major drawbacks include unusual and unfamiliar patient responses such as a conscious-appearing patient that can be unnerving for endoscopists when intubating the esophagus as an example [11]. An increased incidence of laryngospasm is also well documented. Necessary administration of an antisialagogue such as atropine or glycopyrrolate in order to suppress profuse salivation produces uncomfortable anticholinergic side effects such as dry mouth. In adults, it can trigger visual and auditory hallucinations which can lead to the nightmares, thereby limiting its clinical usefulness. Prior administration of benzodiazepines may avoid this particular drawback, although benzodiazepines might prolong the discharge times in the setting of outpatient GI endoscopy. Its ability to maintain spontaneous ventilation and hemodynamic stability is an advantage in a subset of patients undergoing endoscopy. The former category includes morbidly obese, patients with potential airway difficulties such as sleep apnea and those with poor respiratory reserve. Currently, the place of ketamine is at best as an additive to other agents like propofol. The drug might also be particularly suitable in pediatric GI endoscopy.

Dexmedetomidine is a relatively new sedative that is likely to have a small but definite place in the field of GI endoscopy [12]. Experience with this drug is also limited in the field of GI endoscopy sedation. Similar to clonidine (a known antihypertensive agent), it is an α-2 receptor agonist, although specificity for these receptors is 8× higher than clonidine. In doses employed for sedation, it has negligible respiratory depressant activity. The activation of postsynaptic α-2 receptors produces sympatholysis with resultant hypotension and bradycardia. Although the drug possesses analgesic, amnesic, sedative, and anxiolytic properties, its slow onset and prolonged recovery are a major drawback, especially in the setting of outpatient GI endoscopy. As a sole agent, it is unlikely to have any practical application for advanced endoscopic procedures.

In conclusion, propofol remains the drug of choice in the vast majority of patients that require deep sedation for their GI endoscopy. Nevertheless, there are a small group of patients who might not be the appropriate candidates for propofol-induced sedation. A knowledge of alternative options is essential; accordingly, we have summarized the pros, cons and indications for propofol and its alternatives in Table 1.

Table 1 Pros and cons of sedatives used for endoscopic sedation

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Affiliations

Departments of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, 680 Dulles, 3400 Spruce Street, Philadelphia, PA, 19104, USA
Basavana Goudra

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Basavana Goudra.

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Goudra, B. Big Sleep: Beyond Propofol Sedation During GI Endoscopy.
Dig Dis Sci 64, 1–3 (2019). https://doi.org/10.1007/s10620-018-5287-x

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Headache After Colonscopy | Colonscopy Richmond

The good news? Your not-so-eagerly-anticipated colonoscopy is over! The bad news? You now have a raging headache. Is this normal?

Headaches Are a Potential Side Effect of Colonoscopies

While headaches aren’t overly-common after a colonoscopy, they do happen. Odds are you missed this side-effect in the fine-print because you were more concerned with other issues pertaining to your procedure. In almost all cases, a post-colonoscopy headache is nothing to worry about.

However, if your headache is accompanied by fever, chills, abnormal bleeding of the rectum or anus or persistent pain – call your doctor to check in and make sure everything is alright

Here are some of the most common reasons you might have a headache following your colonoscopy:

Sedatives used for colonoscopy procedures can cause residual headaches.

In order to help you experience a stress-free, comfortable colonoscopy – and to help your doctor get a better look inside the colon – it’s important for your colon to be relaxed. A simple sedative – administered orally or via IV – accomplishes all of the above.

However, some of the most commonly used sedatives – such as Versed and Propofol have headaches listed as a potential side effect. Headaches can be compounded if those sedatives are mixed with other sedative or anti-anxiety medications, including Demerol, Valium or Fentanyl.

You may be a bit dehydrated.

As you’re very aware after your colonoscopy preparation, you’ve lost a lot of water. The process of flushing the bowels eliminates almost everything that was previously retained inside them – including liquids. Then, on top of that, the bowels are mildly irritated from the procedure, which makes some people more susceptible to loose stool or diarrhea for up to a few days afterwards. This can cause further dehydration.

Dehydration is one of the most common causes of headaches in general, and may be the culprit in your case. Once you’ve returned home, begin sipping water slowly and see how your body reacts. Coconut water or a low-sugar beverage with added electrolytes might also help. Avoid alcohol or sugary beverages until your headache is gone and you feel back to normal – otherwise, you may find your dehydration headache gets worse.

Make sure to drink the proverbial 10 to 12 cups of water per day to fully re-hydrate again and always follow the post colonoscopy instructions from your doctor.

The let down of adrenaline.

If this was your first colonoscopy, or if you have a natural fear or heightened anxiety associated with medical procedures, you might be experiencing the aftereffects of an adrenaline rush. Often, when we experience stress, we operate in a fight-or-flight mode, causing adrenaline to flood the system – keeping us energized and “in control.”

Once the “threat” (aka your colonoscopy) is gone and the relaxing sedatives wear off, you may find the post-adrenaline rush causes a dull headache. Deep breaths, a good sleep, and proper hydration and nutrition should take care of this within 24-hours or less.

Lack of sleep.

Similarly, stress and/or the colonoscopy preparation experience may cause you to get less sleep than normal the night before the procedure. If you have a natural anxiety around medical procedures, you may have lost sleep for more than one night leading up to your colonoscopy.

Like dehydration, lack of sleep is another top cause of headaches. Once your dedicated driver gets you home safely, try to take a nap and rest as much as you can. Get to sleep earlier than usual that night and take deep breaths to help your system relax. Catching up on sleep might be all you need to make the headache go away.

Your blood sugar is low.

You just cleared your body of liquid and solid waste – along with some nutrients that didn’t have a chance to digest all that well. Then, you had to fast for multiple hours. Depending on your body’s regular blood sugar balance – as well as your metabolism – the headache may be your body’s way of saying, “feed me!”

Help your low blood sugar out by following the post-procedural

Tylenol is your safest best to relieve post-colonoscopy headaches.

Because ibuprofen can irritate the bowels and also works as a blood thinner, we recommend patients take Tylenol or an equivalent off-brand acetaminophen – as directed on the bottle – when experiencing mild headaches after their colonoscopy. This is especially true for patients whose colonoscopy included the removal of polyps or other surgical procedures.

Patients with a persistent or unbearable headache should always contact their physician to verify all is well.

Contact us for more more information or to schedule an appointment with a Colon & Rectal Specialist physician in one of our three Richmond area locations.

Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam

Abstract

Colonoscopy is one of the most common procedures. Sedation and analgesia decrease anxiety and discomfort and minimize risks. Therefore, patients prefer to be sedated when undergoing examination, although the best combination of drugs has not been determined. The combination of opioids and benzodiazepines is used to relieve the patient’s pain and discomfort. More recently, propofol has assumed a prominent position. This randomized prospective study is unique in medical literature that specifically compared the use of propofol and fentanyl with or without midazolam for colonoscopy sedation performed by anesthesiologists. The aim of this study was to evaluate the side effects of sedation, discharge conditions, quality of sedation, and propofol consumption during colonoscopy, with or without midazolam as preanesthetic. The study involved 140 patients who underwent colonoscopy at the University Hospital of the Federal University of Juiz de Fora. Patients were divided into two groups: Group I received intravenous midazolam as preanesthetic 5 min before sedation, followed by fentanyl and propofol; Group II received intravenous anesthesia with fentanyl and propofol. Patients in Group II had a higher incidence of reaction (motor or verbal) to the colonoscope introduction, bradycardia, hypotension, and increased propofol consumption. Patient satisfaction was higher in Group I. According to the methodology used, the combination of midazolam, fentanyl, and propofol for colonoscopy sedation reduces propofol consumption and provides greater patient satisfaction.

Resumo

A colonoscopia é um dos procedimentos mais feitos. Sedação e analgesia diminuem a ansiedade e o desconforto e minimizam riscos. Em razão disso, os pacientes preferem que o exame seja feito sob anestesia, embora não tenha sido determinada a melhor combinação de fármacos. A associação de benzodiazepínicos com opioides é usada para aliviar a dor e o desconforto do paciente. Mais recentemente, o propofol assumiu posição de destaque. Este estudo, prospectivo e randomizado, é único na literatura médica e especificamente comparou o uso do propofol e fentanil associado ou não ao midazolam na sedação para colonoscopia feita por anestesiologistas. Os objetivos do estudo foram avaliar os efeitos colaterais da sedação, as condições de alta, a qualidade da sedação e o consumo de propofol durante a colonoscopia, com ou sem o midazolam como pré-anestésico. Envolveu 140 pacientes submetidos à colonoscopia, no Hospital Universitário da Universidade Federal de Juiz de Fora. Os pacientes foram divididos em dois grupos. O Grupo I recebeu, por via endovenosa, midazolam como pré-anestésico, cinco minutos antes da sedação, seguido do fentanil e propofol. O Grupo II recebeu, por via endovenosa, anestesia com fentanil e propofol. Os pacientes do Grupo II apresentaram maior incidência de reação (motora ou verbal) à introdução do colonoscópio, bradicardia, hipotensão arterial e maior consumo de propofol. A satisfação dos pacientes foi maior no Grupo I. De acordo com a metodologia empregada, a associação de midazolam ao propofol e fentanil para sedação em colonoscopia reduz o consumo de propofol e cursa com maior satisfação do paciente.

Keywords

Sedation

Colonoscopy

Propofol

Fentanil

Midazolam

Palavras-chave

Sedação

Colonoscopia

Propofol

Fentanil

Midazolam

Citing articles

90,000 Risk of complications after colonoscopy under general anesthesia

Relevance

Conducting colonoscopy under general anesthesia significantly increases its cost without significantly increasing quality and can have negative consequences.

Canadian investigators evaluated the complications associated with colonoscopy under deep sedation (propofol). Specifically, the researchers focused on bowel perforation, aspiration pneumonia, and spleen injury.

Study design

A population-based cohort study included adults who lived in Ontario, Canada and who had a colonoscopy from 2005 to 2012.

The primary study endpoint was the incidence of bowel perforation. The secondary study endpoints considered the incidence of aspiration pneumonia and spleen injury.

Complication rates were compared in subjects who underwent endoscopic examination under anesthesia and without anesthesia.

Results

Scientists analyzed data from 3,059,045 colonoscopies performed on an outpatient basis, of which 862,817 were performed under anesthesia.

Complication rates were compared in 793,073 individuals undergoing anesthesia and 793,073 individuals without anesthesia. 90,035 90,034 51% of the individuals included in the analysis were women, 78% were 50 years of age or older.
The use of anesthesia was not associated with a significant increase in the risk of perforation (odds ratio, 0.99; 95% CI, 0.84-1.16) and with an increase in spleen injury (odds ratio, 1.09; 95% CI, 0 , 62-1.90).
However, the use of anesthesia increased the risk of aspiration pneumonia (odds ratio, 1.63; 95% CI, 1.11–2.37).

Conclusion

The results of a population-based cohort study indicate that colonoscopy under general anesthesia is associated with an increased risk of aspiration pneumonia. The risk of intestinal perforation and damage to the spleen is not increased.

Source: Barbara Bielawska, Lawrence C. Hookey, Rinku Sutradhar, et al.Gastroenterology 2018; Volume 154, Issue 1: 77-85.e3.

Sedation (Anesthesia) for Colonoscopy | One Clinic

Sedation – anesthesia for colonoscopy and other procedures in One Clinic

The Center for Contemporary Medicine Online Clinics offers everyone who wants to undergo various medical procedures under sedation, that is, in a state of deep physiological sleep.

Sedation is one of the methods of anesthesia

Sedation is a type of pain relief when, with the help of special preparations, the patient is immersed in a state of superficial drug sleep.A person plunges into a drug-induced sleep and into a state of serenity, calmness and equanimity.

Application of the anesthetic drug “PROPOFOL”

At Online Clinic, the use of sedation allows the patient to feel comfortable and not feel any painful manifestations during procedures such as colonoscopy, FGDS, videoanoscopy, sigmoidoscopy, intimate plastic procedures, and other operations in gynecology.

After the injection of the drug into a vein, the patient plunges into a state of sleep, feels completely relaxed both physically and emotionally, all his sensations are dulled so much that he does not feel pain at all, but experiences a state of peace and tranquility.

With proper sedation, the respiratory center is not suppressed, so the patient can breathe spontaneously without any disturbance. And this, undoubtedly, is another advantage of this type of pain relief.

In the event that breathing problems still arise, the anesthesiologist Only Clinic is always ready to resolve these situations, using special anesthetic techniques and devices for this. In order to recognize side effects in time and immediately provide the necessary assistance, during the entire time when sedation is applied, an anesthesiologist is always next to the patient.

After sedation, the patient either remembers nothing at all about the procedure performed or has very little memories of the past.

According to the experience of working with the use of sedation, specialists of ONLI CLINIC note that the passage of such procedures as colonoscopy, FGDS, rectromanoscopy, anoscopy under sedation was tried by many of those who are panicky afraid of visiting doctors. Most of them are enthusiastic about sedation, as for the first time in their lives they had no fear.Some have retained separate fragments of the treatment in their memory, and some do not remember anything at all.

The main disadvantage of sedation, all patients who went through it, called a rather high price, but at the same time they made a reservation that they would agree to the next visit to a specialist only when it was carried out.

When is anesthesia colonoscopy performed?

In addition to the personal desire of the patient, there are a number of reasons why colonoscopy with anesthesia is indicated.

Doctors endoscopists define several categories of patients requiring anesthesia:

90,033 90,034 children under 12 years of age. As a rule, even a slight pain can traumatize the unstable psyche of a child, so all children undergo a colonoscopy with anesthesia, and nothing else.

90,034 patients with adhesive bowel disease. Adhesion in the abdominal cavity is one of the indications for applying pain relief during colonoscopy.

, the procedure requires mandatory anesthesia if it is performed on a patient with an extensive destructive process in the intestine, which can also be accompanied by severe pain syndrome.

painless colonoscopy is indicated for persons with a low threshold of pain sensitivity.

In order to undergo any procedure in ONLY CLINIC under anesthesia, you must make an appointment with a doctor – anesthesiologist. You must have a cardiogram with you to see the anesthetist. After the end of the procedure, the patient can leave the Clinic only with the permission of the anesthesiologist.

Important!

In such diseases as hypertension, coronary heart disease, diabetes mellitus, there are some peculiarities in preparation for endoscopic procedures Colonoscopy and EGD under sedation:

Tablets for coronary artery disease, hypertension and other chronic diseases are allowed to be taken 2 hours before the examination and washed down with 100 ml of water.
In the case of an appointment for endoscopic examinations in the first half of the day (before 12 noon), the morning intake of hypoglycemic drugs must be excluded.
Patients taking long-acting insulin should cancel the morning injection. It is possible to take sweet water 2 hours before the examination, no more than 150 ml.
Patients diagnosed with the above diseases are advised to make an appointment for Colonoscopy and EGD under sedation in the morning hours of admission.
If necessary and individualized, the patient is provided with a free consultation with an anesthesiologist.

FGDS and colonoscopy under “anesthesia” (medication sleep) at the Gastroenterological Center Expert

FGDS (video gastroscopy) and colonoscopy (video colonoscopy) – endoscopic examinations conducted for the purpose of visual “assessment of the state of the mucous membrane” and the “lower” parts of the gastrointestinal tract (colonoscopy).In our center, these studies are performed using the modern video endoscopic system of the Japanese company PENTAX Medical with a high-resolution matrix . All necessary images and stages of the study are saved and can be recorded on an electronic data carrier (at the request of the patient).

Most people perceive endoscopic examinations (especially colonoscopy) as extremely unpleasant, painful procedures and therefore postpone their visit to the doctor and the examination itself for years.Because of this, precious time is lost: diseases detected in the early stages can be treated more effectively than neglected ones.

In some cases, due to pain and other unpleasant sensations and psychological characteristics of the patient, endoscopic examinations are generally impossible.

General anesthesia in the form of short-term “drug sleep” comes to the rescue. In the Expert center, there is an opportunity to carry out FGDS and colonoscopy with all types of modern anesthesia, which allows patients to transfer the procedure with maximum comfort.

How is medication sleep carried out?

For carrying out medication sleep in our Clinic we use the drug Propofol (Diprivan), which belongs to ultra-short-acting hypnotics, does not contain potent and narcotic substances. With intravenous administration of the drug, after 20-30 seconds, a state close to physiological sleep occurs. In this case, the patient does not experience unpleasant sensations, including pain. Medication sleep in our center is carried out under the supervision of a highly qualified anesthesiologist using modern anesthetic equipment.A few minutes after the end of the study (depending on individual characteristics), the patient awakens. Full working capacity is restored after 30-60 minutes, during which the patient is monitored by the medical staff in the day hospital of our center.

Reference

Anesthetic benefits (anesthesia) for colonoscopy

Colonoscopy is a procedure for examining the large intestine, as well as the end of the small intestine, using a thin flexible fiber-optic device consisting of a light source and a camera that produces an image on a television screen.

Anesthesia during colonoscopy

Different clinics in our country use different types of anesthesia for colonoscopy. It is not uncommon for a colonoscopy to be done without any anesthesia at all, although this medical procedure is quite unpleasant and painful. Sometimes a colonoscopy is performed under local anesthesia when the tip of the colonoscope is lubricated with a local anesthetic. However, local anesthesia during colonoscopy does not provide sufficient comfort for the procedure.

The most optimal and most commonly used type of anesthesia for colonoscopy in European countries is sedation. Sedation induces a dream-like state, while anxiety and fear go away, and all sensations are dulled as much as possible. The most commonly used sedation for colonoscopy is midazolam or propofol. Both of these anesthetic drugs have their own advantages and disadvantages. The advantage of midazolam is that its use does not evoke any memories of the previous procedure in the patient.The disadvantage of midazolam is that it has a longer awakening period after taking it. Propofol provides a quick awakening after sedation, at the cost of some risk of retaining memories of the past colonoscopy.

Another type of anesthesia used in colonoscopy is general anesthesia (anesthesia), which provides a complete shutdown of the patient’s consciousness. While sedation provides comfort in 95-99% of cases of its use, then colonoscopy anesthesia guarantees 100% comfort.However, it should not be forgotten that there is a greater risk of complications associated with anesthesia with colonoscopy than with sedation. For anesthesia during colonoscopy, various drugs from the group of anesthetics can be used. Anesthesia during colonoscopy should be performed only in an operating room, which has all the necessary equipment to ensure the complete safety of the procedure.

Thus, the implementation of anesthesia during colonoscopy is not rational, since the risk from its implementation exceeds the risks associated with the colonoscopy procedure itself, therefore, the most optimal is to conduct a colonoscopy under sedation.

Indications for colonoscopy

Colonoscopy is most often performed for gastrointestinal bleeding, as well as for suspected inflammatory or malignant neoplasms of the colon. Also, another of the indications for colonoscopy is an unmotivated decrease in hemoglobin in elderly patients.

Features of colonoscopy

During colonoscopy, a probe is inserted through the anus into the colon to visually examine the inner surface of the intestine.A colonoscopy may involve some surgical procedure, such as removing a polyp, or taking (biopsy) a small portion of a sample of colon tissue. However, most often colonoscopy is performed for diagnostic purposes.

Time of colonoscopy

The duration of the procedure is from 15 to 60 minutes.

Complications of colonoscopy

In general, the risk of complications during colonoscopy is extremely low and is only about 0.35%.Potential complications of colonoscopy include perforation, bleeding, post-polypectomy syndrome, anesthetic reaction, and infection. Of the possible complications of anesthesia during colonoscopy, the development of an allergic reaction to anesthetics, as well as the occurrence of respiratory problems, is more common.

Article added February 1, 2016

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90,000 Colonoscopy. On a delicate topic without ridicule / Habr

I have been working as a nurse-anesthetist in the endoscopy office for almost 2 years. This time was enough to understand that doctors, the call center of the clinic and the Internet do not always provide all the accurate information on preparing for such a study as a colonoscopy.I tried to collect all the frequently asked questions. I want to share with you, I will be glad if it turns out to be useful to someone.

The modern world gives many people the opportunity to work from home. Especially now, in the “coronavirus” era, even more people work remotely and have stopped commuting. This means that at home they mostly sit, sit for a long time and look at the monitor. To be fair, I must say that office life is not conducive to mobility. I’m not ready to tell you about the harm of looking at the monitor for a long time, but long sitting definitely leads to problems with the gastrointestinal tract (gastrointestinal tract).Plus, many do not drink enough water, do not eat fiber, are stressed, and this all leads to some problems that can last for years. Sooner or later, many come to the need to do a colonoscopy. If you want to learn more about this delicate study in more detail – welcome under cat. The article contains a description of many physiological topics that it is customary to be ashamed of, it may be simply unpleasant for someone, there are also some horror films, so it is better for impressionable persons to refrain from reading.

After consulting a doctor, in addition to tests and ultrasound, an endoscopic examination of the stomach and intestines may be prescribed. And even if nothing bothers about the gastrointestinal tract, it is recommended to examine the large intestine prophylactically for everyone after 40 years of age and repeat every 5 years. And if the family had oncology in the gastrointestinal tract, then the oncological search should be started earlier. About 5 years before the age, as happened with relatives. Just about the colonoscopy of the COP – I will try to make out the examination of the large intestine in detail.

A little bit of anatomy

The large intestine is the rectum, sigmoid, descending colon, transverse colon, ascending colon, and cecum. In total, the length turns out to be 1.5-2 m. The length of the apparatus for the CS is 1.5 m, but this is enough to inspect all the departments, since it is possible to “collect” the intestine with an endoscope. The examination begins with the rectum and ends at the appendix, at the entrance to the small intestine. The place is called Bauginieva damper. All modern devices display the image on the monitor.Therefore, during the study, the doctor can show the patient the found formations or some peculiarities of the intestine. This is the minimum anatomy you need to know to read this article.

Now about the diet before COP

To examine the entire length of the intestine, it must be emptied of its contents. To do this, they came up with solutions that must be drunk before the study. But besides this, you still need to follow a slag-free diet. If the stool is regular (every day), then you need to follow the diet for 2-3 days.More details about preparation preparations will be below. The diet is described in detail in the instructions for the laxative that the patient chooses. Everything is written there, what is possible and what is not. I will not waste time on this. I’ll just clarify why some products are not allowed. Fresh fruits, vegetables and breads are not recommended due to the possible gas formation they cause. Everything that contains small bones, seeds, poppy seeds, nuts is not allowed. All of this lingers in the intestines and can make diagnosis difficult. From cereals you can only semolina.Iron preparations and activated charcoal must be canceled during preparation, as they can stain the intestinal walls, which will also complicate the diagnosis. If you have chronic constipation or stool retention for up to 3 days, then the diet should be followed for 4-5 days.

Preparations

Laxatives are different. It can be a powder for solution or a tablet. You need to drink the drug strictly according to the instructions. Patients have the following options to choose from: Fortrans – 4 liters of solution, 32 Kolokit tablets with water, Moviprep 2 liters of the drug plus 2 liters of water.There are many drugs, I have listed those that are most often used. Good preparation is the key to successful research. The drugs are all tasteless, but you need to overpower yourself. If it is very difficult, “I go there, and it goes back,” wash it down with sweet tea or water. It happens that it was not possible to drink the entire amount, then it is better to postpone the study to another day. Some patients believe that 2 liters of Fortrans is enough, but this is not the case. It will be a pity for the time, nerves and money spent if it turns out that the preparation did not work out.Taking half of the drug is suitable only if you have been fasting for a week, and for 2-3 days before the study, you were kept on teas and broths. Fortrans is calculated based on the patient’s weight, 1 liter per 15-20 kg body weight. But as practice shows, 4 packages are an ideal dose for a person from 60 to 100 kg.

If you don’t feel like drinking “muck”, there is a variant of preparation with enemas. The method is rare, but effective, subject to some nuances. If the study is in the morning, then the day before at 15 o’clock, you must definitely drink 60 ml of castor oil.Wait for an independent chair and then make two enemas, 1.5-2 liters of water each. In the morning, on the day of research, two more are the same. Ready to flow against the current? You can prepare with enemas. In this case, the diet must also be followed, as in the preparation of solutions.

If you started to prepare with solutions and drank less than half of the required amount, it is better not to do enemas. There are times when patients decide to “catch up with enemas” after the solutions. After this, there is usually a lot of fluid in the intestines and this makes examination difficult.

So, you’ve done everything that was required and withstood the runs to the toilet and back. If on the day of the study you still have “preparation leftovers” out of you, that’s okay. But the liquid must be clear. Even if it has yellow tints.

Research

And here you are in the endoscopy room. Try not to get nervous. So that people do not hesitate, now they give out disposable underwear, special for the COP. Shorts with a hole in the back and / or a robe.

Colonoscopy is unpleasant and can be painful.Mainly due to the swelling of the intestines with air that the doctor pumps with the apparatus. This is necessary to straighten the folds of the intestine. All this is endured in different ways. Someone already at the entrance to the rectum screams and cannot stand, someone lies calmly until the end of the study. I note that the device is lubricated with gel, it slides easily, despite its threatening dimensions:

This will be inserted inside

During the procedure, you need to feel free and release the air that breaks out, it will be easier.The COP lasts from 15 to 40 minutes approximately. For those who are in great pain, there is an opportunity to have a CS under general anesthesia. But more on that below. The doctor slowly advances the apparatus through the intestines, carefully passing all the bends and loops. The most unpleasant moments are precisely the passage of the bowels bends. During the examination, you may be asked to press your stomach in a specific place, or a doctor’s assistant will do it. This is necessary to fix the intestine if it is difficult to pass any area.

By the way, the very examination of the intestines takes place exactly on the way back of the apparatus.If any pathology is found in the form of polyps, etc., then a biopsy is taken. A biopsy is taking a piece of any formation or mucous membrane to determine the composition. It doesn’t hurt at all. The device has a special channel for the introduction of forceps, they look like this:

If a large tumor is found in the intestine, covering almost the entire lumen of the intestine, then the doctor can finish the examination on the way “there”. The area of the intestine in which the tumor has arisen has a “loose” structure, and if you also pull it mechanically with the apparatus, then there is a risk of tearing it.But a biopsy will be taken from the tumor. The analysis is usually prepared within 7-10 days.

Diverticula may still be found. These are small protrusions in the intestinal wall outward. The so-called “pockets”. They are formed, for example, with frequent constipation, which in turn contribute to an increase in intraintestinal pressure. Over time, habitual protrusions form in the intestinal wall, which can lead to clogging of diverticula with intestinal contents. This is what the diverticula (small dark depressions) look like:

Sorry for the not very good quality, I shot during the study

This may cause abdominal pain.If, after many years of constipation, the stool is adjusted, then the diverticula will not remind of themselves, except on the screen during the study. As a rule, they are not treated or operated on. You just need to make sure that there is no constipation.

Almost all of the listed intestinal pathologies may not manifest themselves in any way. And only during the study do people learn about polyps, diverticula, and even colon tumors. That is why, as I already wrote at the very beginning, CS is recommended to be done prophylactically to everyone after 40 years.

After detecting polyps and taking a biopsy, you are advised to observe or remove this polyp, depending on its size. Small up to 1 cm, observe, i.e. do a cop every year.

The polyp on the monitor looks like this (in the center of the frame):

Such a large polyp should be removed, and the study should be repeated a year later to find out if new ones have grown.

In some clinics it is possible to remove polyps immediately during the CS. Sometimes it happens that the polyps are so small that they are removed during the biopsy.Large polyps are best removed in a hospital. There it is possible to leave the patient under the supervision of doctors for a day. This is necessary because bleeding may develop after removal.

Completion of procedure

The doctor will try to take air from the intestine with the apparatus on the way back, but a little may remain. Therefore, do not be surprised if the pants in which you came for the study will not button up. After the COP, this air will leave the intestines on its own. This is normal. The main thing is not to keep to yourself and not to make important meetings for this time.You can start eating and drinking as soon as the doctor gave you the test result and you left the office. There are few restrictions: on this day, it is better to limit fresh vegetables and fruits, soda and fresh bread. This is all due to the gassing that they can cause. And it is advisable not to eat a lot at once. No preparations are needed to restore the intestinal microflora. Preparation solutions do not wash out microflora.

After the examination, the device is washed by a medical worker with brushes and special means, and then it is put into a washing machine, which additionally processes the device by driving out streams of des.funds through all internal channels. The device is laid to wash:

Study option under anesthesia (sedation)

For those who cannot tolerate pain or do not even want to try, there is an option to do a CS under general anesthesia. This is exactly my specialty in the endoscopy room. I help the anesthesiologist during the examination. This is not anesthesia, as in a real operating room, this is a medication sleep. The patient is asleep, and at this time he is doing research. This is much more comfortable for the patient and the doctor too.If you need to “fix the intestine”, i.e. to press the stomach in a certain place, the paramedics will help.

I want to note that usually you need to immediately decide whether you want to do in a dream or not. Come and try without anesthesia, and if it hurts, then change your mind – it will not work. But check this option with your clinic.

Before the CS without sedation, the patient may drink some water. And for medication sleep, this is a contraindication. Before sedation, the patient should stop taking fluids within 6-8 hours.Because there is a risk of passive leakage of gastric contents into the upper respiratory tract, which threatens unpleasant consequences, such as laryngospasm or bronchospasm. Which in turn can lead to respiratory failure. This is a very rare complication during sedation, but it is nevertheless best not to ignore the advice not to drink before the sleep test.

Sedation or medication sleep

Sedation is the intravenous administration of a sleeping pill to facilitate research into unpleasant or painful sensations.

It is widely used in dentistry, endoscopy, MRI, in some types of plastic surgery, in ENT practice, etc.

Before sedation, a doctor-anesthesiologist talks to the patient. Asks weight / height, the presence of chronic diseases, whether the operations were previously under general anesthesia or sedation, whether the patient is taking any drugs constantly, bad habits, etc.

If there are no contraindications, an intravenous catheter is inserted into the patient through which the drug will be injected.Usually it is Propofol or Diprivan. The active substance is the same, different trade name. This solution is white, opaque, like milk:

Anesthesiologists sometimes call it “unicorn milk”. Acts very quickly. After the introduction of 10-15 ml, pleasant dizziness begins and irresistibly pulls you to sleep. It may tingle slightly on the face, neck and arm just above the injection site, along the course of the vessel. It happens in 30% of people. It goes away very quickly.

The dose is calculated based on the patient’s weight.But there are also exceptions. Sometimes girls 45 kg need the drug twice as much as calculated by weight. And for a man 90 kg, the first single injection may be enough for 20 minutes of sleep. Further introduction continues as research progresses. Usually continue to inject 1-2 ml every 5-10 minutes. The administration of the drug is stopped when the endoscopist doctor begins to examine the intestine on the way back.

After sedation, many patients report that during this time they slept like 8 hours of sleep at home.Propofol really gives a feeling of “sleepiness”. Dreams are usually pleasant. If you think about something good, then there is a high probability that it will be dreamed of. Doctors say so before administering the drug “make yourself a dream.” Those who did not have time or did not believe, dream about work. And yet, after Propofol, everyone is drawn to “talk”.

On average, 10-15 minutes after the end of sedation, the patient can already start to get up, walk, feeling a little dizziness. This is normal. Coffee, tea and food will help you recover faster.After sedation, you must not drive for 24 hours. This is a doctor’s recommendation, no one will take away the keys from the car. The person must decide for himself. Honestly, I do not know whether the presence of the drug in the blood will be determined if an examination is required. But a decrease in reaction on this day can lead to unpleasant consequences.

After sedation, you can eat and drink anything, even alcohol (except for champagne, because it is carbonated). You can also take blood tests. In small doses and for a short time, the drug is not harmful.

Many people ask if it is possible to use such a remedy at home to fall asleep quickly and sleep well. I don’t want to upset, but you can’t use it at home. There is a possibility of overdoing it, and then everything may end in respiratory arrest. Michael Jackson died from this drug. According to the media, he did it at home and once the dose was exceeded. In the clinic, the staff is watching you, the monitor displays the pulse and respiration indicators in dynamics. That is why sedation is performed by an anesthesiologist-resuscitator, who will be able to take the necessary measures if something goes wrong.

Sedation is usually enjoyed by everyone. Especially for those who have already tried colonoscopy without sedation. The only negative, “magic sleep” – the pleasure is not cheap. If possible, it is better to do it in a dream. You will sleep well, the doctor will do the research, wake up as if nothing had happened. No discomfort, except for an injection into a vein. The drug does not relieve pain and it can be painful to pass the bowel curves, but you will not remember it. For you, all this will pass as if in an instant.

After waking up, which occurs in the first minutes, as a rule, patients cannot remember, although they are already conscious.They start asking questions about the research result and then forget that they heard the answer and ask again. Therefore, we try to convince the person that he must wake up completely and then the doctor will tell everything. And if the clinic has the opportunity to record the study on video, then it will show.

I think she told everything she wanted. I hope it didn’t scare you. If you have any questions, ask, I will try to answer everything in the comments.

Clinical Study Colonoscopy: Dexmedetomidine, Saline Placebo, Propofol – Clinical Trials Registry

In this study, the researchers plan to conduct a prospective comparison in a randomized, double-blind, controlled trial of sedation technique for colonoscopy between the two groups.Group 1: sedation with dexmedetomidine and propopfol versus group 2: saline sedation with placebo and propofol.

The study will have the following outcome indicators for each group.

Primary Outcome Measure:

Readiness to Discharge (RFD) 10, 20 and 30 minutes after colonoscopic procedure. Discharge readiness is defined as reaching 9-10 points on the MPADSS scale.

Secondary evaluation criteria:

1. Total consumption of propofol in mg / kg / duration of the procedure in minutes;

2.Side effects:

1.the lowest percentage (%) drop in mean arterial pressure (MAP) during surgery from baseline

2. frequency of persistent attacks of bradycardia (heart rate

3. frequency of apnea episodes during surgery requiring positive pressure Ventilation

Methods:

100 patients will be recruited and randomized into two groups For sedation, Group 1 will receive an IV dexmedetomidine 0.3 mcg / kg bolus at the start of the procedure followed by titration of propofol.Group 2 will receive a placebo saline bolus at the start of the procedure followed by titrated doses of propofol. Hospital Study The pharmacist will assign sedation, dexmedetomidine bolus syringe / or saline to the anesthesia provider based on a randomization table. The anesthesiologist, gastroenterologist, nurses, and the subject will not know the actual contents of the syringe.

Side effects of propofol for colonoscopy. Propofol for Colonoscopy: Side Effects, Warnings, and Uses

Understanding Propofol and Its Role in Colonoscopy

Benefits of Propofol for Colonoscopy

Common Side Effects of Propofol During Colonoscopy

Mild Side Effects

More Serious Side Effects

Precautions and Warnings for Propofol Use in Colonoscopy

Medical Conditions to Disclose

Medication Interactions

Contraindications for Propofol Use in Colonoscopy

Absolute Contraindications

Relative Contraindications

Preparing for a Colonoscopy with Propofol Sedation

Pre-Procedure Instructions

Monitoring and Recovery After Propofol Sedation

Post-Procedure Care

Alternatives to Propofol for Colonoscopy Sedation

Common Alternatives to Propofol

Factors Influencing Sedation Choice

Conclusion

Side Effects of Propofol (Propofol Injectable Emulsion), Warnings, Uses

Puget Sound GastroenterologyPuget Sound Gastroenterology

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Headache After Colonscopy | Colonscopy Richmond

Colonoscopy sedation: clinical trial comparing propofol and fentanyl with or without midazolam

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Sedation (Anesthesia) for Colonoscopy | One Clinic

Sedation – anesthesia for colonoscopy and other procedures in One Clinic

Sedation is one of the methods of anesthesia

Application of the anesthetic drug “PROPOFOL”

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FGDS and colonoscopy under “anesthesia” (medication sleep) at the Gastroenterological Center Expert

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