Expert: Ronald Levy, M.D. - 6/22/2009

Question
Dr Levy:  the answer that you gave on 6/18/09 regarding the different options for colonoscopy sedation was awesome; I have never read so much practical information that was so concise and useful!  I have been delaying much needed arm surgery to correct loss of sensation in my hands (they are going to work on the ulnar and medial nerves) and use a block with a blood pressure cuff as well as the colonoscopy that I was supposed to get 10 years ago since colon cancer runs in the family and I have been having bleeding.  After reading your reply to the question of 6/18, I understand the anesthesia options a little better; I would like to avoid the amnesia drugs if possible, mainly because I have read so many bad experiences with Versed lately, although if I have to have it, I'm o.k. with getting it now that I have read your comments (I liked the roller coaster comparison).  My question is:  if I'm willing to skip the amnesia effects, is there some reason that the providers want to insist on giving sedation?  I was thinking of the painkiller only or nothing for the colonoscopy and painkiller plus the block for the arm surgery, but both providers want to use diprivan anyway.  I would appreciate any opinions on skipping the sedation; I would prefer discomfort to the amnesia any day if I have a choice.  Your answers are awesome!

Answer
I really don't understand why people hate the amnesia. The fact is, if you needed (or received) general anesthesia, you would also be amnestic to what happened in the operation. People don't seem to have a problem with that but they do when it is a sedation. I like to think of sedation as general anesthesia without being asleep. The reason providers want to give amnestics is that we don't like to see people suffer because of misunderstood problems with anesthesia. Our job is to make you comfortable, both physically and psychologically. I will always recommend amnestics and explain why but if the patient insists on not having it, I will comply with their wish (unless thee is a medical reason not to).

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston