Expert: JM Starkman, MD - 2/2/2010

Question
I have read many of your comments and find your candor refreshing.  I'm a hospital pharmacist who is rather terrified of sedation/anesthesia in general because of a bad experience 30 years ago (back in the stone age).  I realize that drugs and techniques have improved since then, but I still try to avoid anesthesia like the plague.   I just had my annual physical and my PCC scheduled me for a colonoscopy (terrible family history and bleeding); I thought that I would have difficulty getting GI to agree to do the exam unsedated, but I was wrong.  The GI doc was a wonderful woman who actually listened to me and agreed to "attempt" the exam unsedated; I accept that it will be painful but that's better than sedation (in my mind). She threw me a curve by having anesthesia see me after our office visit (a real anesthesiologist!) and he told me that "we will stand by during your procedure in case you change your mind about sedation".   Bring a driver, just in case.  When I tried to express my desire for no sedation, the anesthesiologist basically told me "try unsedated but I'm not letting you suffer/white knuckle the procedure..no matter how stubborn you are.   Let me state this: I trust these people with my life; should I just agree to the possibility of sedation (propofol and it's free)??  The GI doc says that I don't have to sign the sedation consent for the test, but everyone (my wife, PCP, etc) says that I'm nuts not to do so.
The GI doc even says that unsedated patients make her rush the exam meaning that quality suffers.  My initial plan was to refuse even an IV (no possibility of drugs), but now I feel stupid for even thinking of this.  Any suggestions; my wife says let them do their jobs and my PCP says " a real anesthesiologist is going to do your sedation; don't wprry be happy"...any comments? Thanks

Answer
Your anesthesiologist sounds a little 'holier-than-thou' ("Im not letting you suffer..") that's YOUR decision alone--not his.  But in the end, your gastroenterologist/anesthesiologist team seem like they are quite in your corner having taken the time to arrange to hear your concerns and alleviate them.  Most importantly, the gastro' is concerned about her ability to do a thorough exam--something many gastroenterologists do not do....they just rush through a cursory evaluation to justify billing an insurance company or the govt for the exam.  [Consider my medical school lab partner who is a gastroenterologist--his partner did a "quickie" colonoscopy on him a year and a half ago, and he is dying of metastatic colon cancer today.]

Yours doesn't sound like the quickie team.  So....my bottom line in your case is to go ahead with the exam with an i.v. and the anesthesiologist on standby.  Be sure and thank him for minimizing the anesthesia in advance!  (You should know that anesthesiologists have a strong incentive for rapid recovery/"wake-up" since it is they that must deal with patients with complications in the recovery room and facility managers wanting to know why their recovery areas are being 'backed-up' with patients slow to recover and not 'moving through' the system.) I suspect this will go better than you think--and I'm with you:  keep it to a minimum.

Write me back and let me know how it went!