Expert: Ronald Levy, M.D. - 6/18/2009

Question
Hi Dr-Your answers to the previous colonoscopy sedation questions are really helpful.  I just got back from the GI doc and she told me that I need a colonoscopy and was gerat with the details; she also told me that I would need them yearly, for a while so I would like to get the sedation part right. I asked her about the consent issue and she told me that they would do whatever we agreed to; she did acknowledge that they basically do the tests with Versed because of insurance issues (mine covers diprivan).  She gave me 4 options:  1. nothing, 2. Versed and fentanyl, 3. propofol with the anesthesia person, 4. fentanyl painkiller only to avoid the amnesia which is important to some people (I'm not sure why).  Although I only met this doctor briefly, I trust her completly.  All of the options cost nothing extra and she said that they are all safe.  She had one exam herself with nothing, but did not recommend it, saying that her next one would be with propofol or Versed/fentanyl with a preference for the propofol because of better sedation and monitoring (which I didn't understand and didn't ask).  thanks!

Answer
Either option 2 or 3 are fine. Both will be pain free, both with give amnesia and both will be a safe. The only difference is that with option 3 you have an anesthesiologist monitoring you instead of the GI nurse. Not to take anything away from the GI nurse but if I had the option (and there was no cost difference), I'd go with the anesthesiologist.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston