Expert: JM Starkman, MD - 7/10/2009

Question
I had a horrible experience with conscious sedation with Versed in the past (and this seems to be fairly common) and I shared this experience with the GI doc who scheduled my colonoscopy.  I told her that I would do the procedure unsedated and she agreed; she seemed empathetic about the bad Versed experience.  When I reported for the exam I was met with a CRNA who insisted that I submit to propofol, joking about Michael Jackson but telling me that I have to have some sedation for this test (I know this is not true).  When I insisted on an unsedated test, she got really mad and told me that I was wasting her time (everybody gets sedation) and that I would be charged if I cancelled the test.  Obviously, the test was not done and my symptoms are getting bad.  My question is:  when you ask for no sedation because of a bad Versed experience, does this mean that you agree to propofol?  This sounds ridiculous to me, but maybe I'm wrong. I don't even know why a CRNA got involved, but now I'm certianly afraid of getting any type of sedation.  Thanks4

Answer
Deplorable.

I read this more as a medical-legal issue than a medical/anesthesiology issue per se, and it really upsets me that physicians (your gastroenterologist and the anesthesiologist supervising the CRNA) are letting this sort of thing go on. A patient must CONSENT for any treatment, etc....and any treatment without consent may very well constitute a battery.
 A colonoscopy would be considerably uncomfortable without a degree of sedation, however I think you and many patients who would be willing to tolerate five to ten minutes of moderate cramping ought to be "allowed" to do so:

(distending one's colon with air to see "where the gastro' is going" causes the cramping--and is a problem while the scope is being introduced up and into the cecum---on pulling back from the cecum, the colon contracts back down with little in the way of symptoms, and several gastroenterologists with which I work ask that I 'cut back' on the propofol sedation during the pull back part as they feel it's not necessary at that point)

The answer to your question is 'no'.....requesting no sedation means just that.  It may mean you also request no monitoring or other 'help' from the anesthesiologist (or CRNA),which if you're mostly healthy is not necessary anyway.  Which will mean that the CRNA and/or anesthesiologist will have no standing to bill you or your insurance company for services.  ?Get it now?

Let your gastroenterologist know that you want to proceed with the colonoscopy.  If she is not willing to tell the anesthesia providers that yours will be done without sedation, change doctors, or reconsider your position with respect to propofol sedation--which leaves very little in the way of residual effects.