Re: Colonoscopy prep question for Howard


"Pete" <pete@xxxxxxxxxx> wrote in message
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Howard McCollister wrote:
"REP" <rep@xxxxxxxxxx> wrote in message
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In article <11vvq7o35cpe541@xxxxxxxxxxxxxxxxxx>,
"Pete" <pete@xxxxxxxxxx> wrote:

Absolutely...especially now that they put you to sleep with
propofil :-) .

It's been a while since I've had a colonoscopy, mostly because I have
the true paradoxical reaction to Versed (it wakes me up and keeps me
awake) and my problem was finally found to be very mild inflammation
in the small intestine, where a colonoscope wouldn't reach anyway.
In case one is suggested again, is propofil preferred over Versed
now?

Most common meds used in intravenous conscious sedation, as for
endoscopy, would be Versed, plus either Demerol or Fentanyl. If, for
whatever reason those don't work for a particular patient, then
Propofol as a continuous drip, is used. Usually, Propofol requires an
anesthetist or anesthesiologist since monitoring is quite critical.

HMc

Howard...I had the conscious sedation in the 90's, but it seems that all
the gastro's have gone to the propofol at the endoscopy and surgical
centers nowadays, so now you get an additional bill from the
anesthesiologist (who has to talk to you and be nearby, even though an
anesthetist does the administration of the drug).

My current gastro uses Versed for my EKG's and saves you the extra bill
(he's from the old school and says the anesthesiologist is overkill - I
agree but the propofol is good stuff - quick acting, quick recovery and no
hangover). When my gastro does my EKG's he has the nurse give 100 mg of
demerol first, and then knocks me out with the Versed, and believe me
there is no consciousness (even though it is referred to as conscious
sedation). And it lasts a lot longer than the propofol, and more hangover,
so he must use a good amount. When I had the conscious sedation in the
90's, I was partially awake during the procedures, and did not go
unconscious.

It seems a shame that they have gotten away from the conscious sedation
where the gastro could inject Versed or whatever into your IV, without an
anesthesiologist and anesthetist being required, and the additional bill,
etc. I suspect it's all related to insurance, and someone didn't wake up
once, or some horse*** like that...Pete


I'm sure it varies from region to region, but doing colonoscopy under
propofol is uncommon. There's cerainly no monetary advantage to doing so,
nor is there any advantage to the patient from a discomfort standpoint
(assuming the IVCS is done properly). In my case, my daily volume of
colonoscopies is such (in addition to my surgical schedule and office
schedule) that the time involved in getting anesthetists involved for
endoscopy is prohibitive (I would need three anesthetists just for
colonocopies). The only time we use an anesthetist/Propofol is if the
patient has in the past required an excessive amount of Versed and/or
narcotic, or if we reach a certain level of administered IVCS and haven't
achieved satisfactory sedation and comfort.

I don't get to collect any more money for administering the IVCS, but it's
cheaper for the patient, safer, and makes for a much more efficient
outpatient unit.

HMc



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