QUESTION: I may need an upper endoscopy/EGD where they use Propofol. I know the person is asleep, but still have lots of apprehension. I sometimes gag on a toothbrush, so just the thought of even a thin tube down my throat into my stomach scares me. Do people ever wake up gagging during the procedure?(maybe because enough of the drug wasn't given?). And even when asleep, does Propofol TOTALLY suppress the gag reflex? Thank you much.

ANSWER: Hey Lee,

Thank you for the question.  I'll do my best to answer it.

Depending on the anesthesia provider, and their 'technique' with propofol, it's not uncommon for people to experience a few different things during the procedure, such as coughing, grabbing toward thin tube, move, etc.  It's also not uncommon for someone to not move one bit for the entire procedure.  This would basically be considered a dose and response relationship.  That being said, propofol is also an amnestic (causes one to not remember goings-on during the procedure).  The more one gets, the more one is amnestic, and hence the less one moves.

So, in short:

Yes, sometimes people do "wake" up, but not in the true sense like you would when awaking from a nap, etc.  Chances of waking up and remembering that moment are not likely, but possible, depending on how deep the sedation is (essentially the patient's response is dependent upon dose).

Yes, propofol can completely suppress the gag reflex.  Again, this goes hand in hand with the amount given, how fast given, the patient's overall response to medications, etc.

I hope this has helped some.  Feel free to ask any further questions.

And thanks again!

---------- FOLLOW-UP ----------

QUESTION: Thanks. When you say people can cough or grab toward the tube, etc., would they be doing that in their sleep, as if they were having a bad dream, or would they know what's going on? And do you know if it's common for people to  have 'dry heaves' because they feel like they are choking? I must say, it sounds like it could turn out to be a very unpleasant and frightful experience. Should I just ask to make sure I'm put under deep enough, but then there's the concern of being given too much and becoming Michael Jackson.


Propofol causes a disinhibition of sorts, so it would be like doing things in your sleep, but not remembering after the fact.  Kind of like sleep-walking.  As for the dry heaves, it's not all that common to feel queasy, since propofol actually helps with nausea/dry heaves.

In all honesty, most people awaken from these procedures quite surprised how comfortable they feel, and how much they actually don't remember, if at all.  Most say the last thing they remember is either going to the OR or being in the pre-op area, just before heading to the OR.

And remember, Michael Jackson was receiving propofol from inappropriately trained hands, was not being monitored appropriately, and was being treated in an inappropriate environment.  

You shouldn't worry yourself too much.  People are quite happy with the results of the anesthesia, way more often than not.  

I hope this helps allay some concerns.  And feel free to ask any further questions.  


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Dino Kattato MSNA CRNA


Former ICU/ER RN with several years of experience. I can answer questions relating to the CRNA education process, professional issues involved, as well as questions about adult and pediatric clinical anesthesia.


Level I regional Trauma center dealing with simple to complex patient populations of all ages. Experience with general anesthesia, spinal and epidural anesthesia, and total IV anesthesia for all surgical specialties including neuro, ortho, general surgery, vascular, electrophysiology, and VIR, with the exception of cardiac anesthesia. Ambulatory surgery center dealing mostly with ENT, plastics, and eyes (70%:30% peds:adults).


AANA Journal February 2010 Feb;78(1):24-7.


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