Anesthesiology/declining colonoscopy sedation
Hi Mike: I hve read your responses to various anesthesia questions and I am impressed with your knowledge and honesty. My question involves sedation for a colonoscopy; I do not want it because of previous adverse reactions (severe), but I have been pressured to accept sedation to get the exam. I have the FAP gene, which makes regular colonoscopy a required event. I have had a severe reaction to Versed in the past; agitation, memory loss and panic attacks, plus it caused difficulty breathing (a horrible experience),so I naturally do not want this drug. I was given "conscious sedation" twice; once with Versed/fentanyl, which lead to a horrible reaction and an aborted colonoscopy..a repeat exam was supposed to be problem-free; I asked that Versed not be used, but the gave Versed/fentanyl/propofol..the side-effects were so severe that they didn't even start the exam. I now do not trust sedation of any kind ( with my experiences, I doubt thatany resonable person would consent to sedation), so I request unseated exams. The endo center agrees to no sedation, but on the day of the exam (yesterday) a CRNA insists that I sign a sedation consent "just in case". I tell her that I'm not consenting to sedation under any circumstances, but she still insists on me signing the sedation consent! I politely decline to sign, but she follows me into the endo suite insisting that the procedure will me impossible without her services. I'm only confused as to why she would insist on being present during the exam when I have made it perfectly clear that I do not want sedation or drugs of any kind (my 2 previous experiences with conscious sedation have convinced me not to consent to sedation ever again). The endo doc agrees and says that she has a lot of complains from patients that receive Versed; despite this, the crna follows me into the endo suite insisting that I sign a sedation consent. The crna was so disruptive that I cancellen the exam. A nurse in the endo centertold me that yjr crna's why would I ever sign a sedation consent if I'm refuasiactions probably stem from her desire to bill my insurance for an anesthesia fee even though I'm not consenting to any anesthesia or related care. Why sign a consent for sedation that I'm refusing? If the exam is too painful, the endo doc will abort. I was told to reschedule at the hodpital so that an anesthesiologist could do my case. This changes nothing.How I communicate that not consenting to sedation means exacty that?
Thanks for the question and I will do my best to answer!
I am so sorry for your experiences so far they sound horrible and I do not blame you for being concerned at all.
I have had a few cases where patients have wanted to try and get through the exam without any medicine at all. Not because they have had bad experiences but because they wanted to watch the exam and see if they could do it. These individuals did sign the consent simply so that i could give them medicine if needed. To date, none of them have been able to finish an exam without medicine. Now this example is very different from your situation but I mention it just to give you an idea of why that CRNA may have wanted you to sign the consent 'just in case'. That individual obviously did not understand your experiences. No worries about billing, they cant bill unless services are needed ;)
The best thing to do is be very clear from the beginning that not only will you not sign the consent but that you would rather abort the procedur than have anesthesia services. If that isnt clear enough I cant image what could be!
I hope your next experience is better and people actually LISTEN to you!