Expert: JM Starkman, MD - 7/19/2009

Question
I have had 2 colonoscopies which were utterly horrible.  I was assured I would be
"out" for the procedure, but I remember everything and the pain was terrible.  I
am now due for number 3 but am very fearful of another bad experience.  Can I
be given general anesthesia?  I am willing to pay out of pocket for whatever the
cost.

Answer
I suspect, but do not know for certain, that your previous two colonoscopies were done by a gastroenterologist--well-qualified to evaluate your colon, but who also acted as 'anesthesiologist'---without any formal training as such.  These are well-meaning, but not up-to-date or state-of -the-art practitioners insofar as anesthesia standards and methods go.  Many have told me personally that they've had "no problems" doing the anesthesia part of the procedure, however on further examination, don't consider recall (patient remembering the procedure), a week's worth of amnesia or respiratory/cardiac arrest during the procedure a "problem"(!).

Many, many gastroenterologists today utilize the services of anesthesiologists to provide for the anesthesia/sedation part of the colonoscopy.  When insurance does not pay for the anesthesiologist most groups charge the patient directly $175 to $250 and provide for the service--a pretty good deal since it near guarantees the above complications don't happen at all.  The gastroenterologist's eyes and mind are free to concentrate on the specifics of the colonoscopy under this gameplan as well.  It is the way I had MINE done.

I'd advise you to simply request an anesthesiologist when scheduling your next colonoscopy---you're the patient and ought to be able to have it your way* [*for now.  The national health care debate is beyond the scope of this forum.]  As I've told an awful lot of others in this forum, if your don't get what is reasonable when politely asked, find another gastroenterologist.  Make sure your procedure consent specifies who will give the anesthesia.   The anesthesiologist is trained to make the best decision for you with respect to the nature of the sedation, anesthetic, dosing and recovery, etc.

By the way, I have no information about you specifically--only that you had a horrible experience which may imply a reason your anesthesiologist/gastroenterologist had to "back off' his administration of sedative medication.  ?Are you morbidly obese? Have a history of heart attacks?severely anemic? Don't lose sight of the fact that "horrible" could really mean that you were not overdosed to the point of irreversible anesthesia complications..............