VIEW ALL BLOG POSTS Posted May 23, 2017 by Benjamin Krevsky, MD, MPH
Many people are nervous about getting a colonoscopy performed. The most common concerns are the preparation, the need to take time off from work, finding out that they might have cancer, embarrassment and pain during the procedure. This prevents many individuals from having the very procedure that could save their lives.
While most people know that there have been great improvements in the cleansing preparations (less volume, better taste), and less time off from work (open access colonoscopy eliminates the office visit needed prior to the examination), very few people know much about the types of sedation that are available.
First, it will be helpful to define the various levels of sedation that are possible.
None. That means that no medications are given. ‘Nuf said. Very few people choose this option. Light sedation. This is just what it sounds like. Although one is sleepy, the patient can still respond to verbal commands and can feel pain. There is no effect on breathing or cardiovascular function. Moderate sedation (also called Conscious Sedation). This is a little deeper than light sedation, yet the patient can respond purposefully to verbal or physical stimulation. There is usually little or no effect on ventilation or cardiovascular function (low risk). Most patients will have no memory of the procedure while under moderate sedation. Deep sedation. This is deeper still, and patients will respond to repeated painful stimulation, but usually non-purposefully. Breathing may be impaired, as may cardiovascular function. The patient will have no memory of what happened while under deep sedation (amnesia). General anesthesia. In this case, the patient does not respond to painful stimulation at all. Breathing is usually impaired, and airways support and ventilation are usually needed (e.g., a tube placed in the lungs and a ventilator machine providing air). Cardiovascular function may be impaired as well.
The level of planned anesthesia determines who will be administering the sedation. For example, light or moderate sedation are usually administered by the gastroenterologist performing the procedure. Deep sedation and general anesthesia are administered by a nurse anesthetist or anesthesiologist.
Most patients tell me that they want to be totally asleep during the procedure (“Just knock me out, Doc.”) That would mean general anesthesia. But this level has a higher risk for a complication, so when I explain the options, most patients are agreeable to a lower level of anesthesia.
Pros and Cons of Different Levels of Sedation for Colonoscopy
None. I perform totally unsedated colonoscopy about once or twice a month. This is in patients who – for various reasons – do not want any sedation. The big advantage is that the patient recovers immediately after the procedure and can go to work or drive right away. They do not need anyone to accompany them home. It also eliminates the possible complications that can occur with any form of anesthesia. While the procedure itself can cause some cramping or gassy abdominal pain, this can be minimized through the use of carbon dioxide to inflate the colon and special techniques to advance the scope. If you want this, make sure that the gastroenterologist has experience doing unsedated colonoscopy. You don’t want to be the doctor’s first one! Light sedation. This is rarely done. Since medications are administered, the risk of complications is present. Also, the patient will need to be accompanied home and should not do regular activities until the next day. But since the sedation is light, there is no effect on pain –the patient feels and remembers everything. Moderate sedation. This is one of the most common forms of sedation used. The medications are usually midazolam and fentanyl – a mild sedative and a pain killer. This is a nice, safe combination, and usually causes amnesia for the procedure. The risk is if too much is given. To avoid this, it is given slowly, with appropriate monitoring. At Temple University Hospital, the doctor and a nurse are with the patient the whole time. The vast majority of patients are satisfied with this sedation. MAC. This stands for Monitored Anesthesia Care. It is administered by an anesthesia professional who is in the room with the gastroenterologist and a nurse or technician. This is usually selected when there are concerns about the patient’s lungs, heart, or tolerance to midazolam or fentanyl. The medicine used for this type of sedation is propofol - yes, the same medicine that was abused by Michael Jackson. However, unlike Michael Jackson, the propofol for colonoscopy is given by a trained professional under constant supervision and monitoring. The depth of sedation with MAC is sometime moderate sedation, but is usually deep sedation. General anesthesia. This is almost never used for colonoscopy. General anesthesia is usually reserved for patients with severe lung disease, unstable airways, and particularly long procedures.
So How Do I Decide What Type of Sedation I Should Get for My Colonoscopy?
It’s simple – talk to your doctor. If you are meeting with the gastroenterologist before the procedure, simply ask what type of sedation is planned. Discuss the pros and cons, and of course, your preferences and concerns. If you are scheduled for open access colonoscopy, you can call the office of the gastroenterologist prior to the procedure to see what is planned. If you want to discuss the sedation further, you should be able to speak with a nurse or doctor prior to the procedure to allay your concerns.
While we can’t make the bowel preparation more pleasant, we certainly can make the actual procedure a comfortable one
看到有网友要做肠镜，胃镜，想起一个实际例子。朋友X，去国内一家医院做胃镜。医生竭力推荐无痛胃镜，说这样好，没有任何不适。X接受了这个建议。原来无痛胃镜 = 全麻胃镜。但做完胃镜后第二天，就发现咽喉不舒服，吞咽困难。后来有段时间经常吃东西时咽不下去，咳不出来，非常难受，而且出现胃食管反流。X怀疑医生做胃镜时出了点问题，但X的家人认为不会。现在几年过去了，到底是怎么回事，不清楚，也无法弄清楚了。
X和我交谈时，我说，我做过肠镜和胃镜，都拒绝用麻药。除了考虑麻药的副作用，另一个考虑就是我的意识清醒，医生镜检时可能会小心一些，动作柔和一些。
医生的责任心和爱心是最重要的，绝大多数医生是好的。我的经验，不用麻药，镜检时有点难受，但可以忍受。
我做的是上麻。
During My Upcoming Colonoscopy?
VIEW ALL BLOG POSTS
Posted May 23, 2017 by Benjamin Krevsky, MD, MPH
Many people are nervous about getting a colonoscopy performed. The most common concerns are the preparation, the need to take time off from work, finding out that they might have cancer, embarrassment and pain during the procedure. This prevents many individuals from having the very procedure that could save their lives.
While most people know that there have been great improvements in the cleansing preparations (less volume, better taste), and less time off from work (open access colonoscopy eliminates the office visit needed prior to the examination), very few people know much about the types of sedation that are available.
First, it will be helpful to define the various levels of sedation that are possible.
None. That means that no medications are given. ‘Nuf said. Very few people choose this option.
Light sedation. This is just what it sounds like. Although one is sleepy, the patient can still respond to verbal commands and can feel pain. There is no effect on breathing or cardiovascular function.
Moderate sedation (also called Conscious Sedation). This is a little deeper than light sedation, yet the patient can respond purposefully to verbal or physical stimulation. There is usually little or no effect on ventilation or cardiovascular function (low risk). Most patients will have no memory of the procedure while under moderate sedation.
Deep sedation. This is deeper still, and patients will respond to repeated painful stimulation, but usually non-purposefully. Breathing may be impaired, as may cardiovascular function. The patient will have no memory of what happened while under deep sedation (amnesia).
General anesthesia. In this case, the patient does not respond to painful stimulation at all. Breathing is usually impaired, and airways support and ventilation are usually needed (e.g., a tube placed in the lungs and a ventilator machine providing air). Cardiovascular function may be impaired as well.
The level of planned anesthesia determines who will be administering the sedation. For example, light or moderate sedation are usually administered by the gastroenterologist performing the procedure. Deep sedation and general anesthesia are administered by a nurse anesthetist or anesthesiologist.
Most patients tell me that they want to be totally asleep during the procedure (“Just knock me out, Doc.”) That would mean general anesthesia. But this level has a higher risk for a complication, so when I explain the options, most patients are agreeable to a lower level of anesthesia.
Pros and Cons of Different Levels of Sedation for Colonoscopy
None. I perform totally unsedated colonoscopy about once or twice a month. This is in patients who – for various reasons – do not want any sedation. The big advantage is that the patient recovers immediately after the procedure and can go to work or drive right away. They do not need anyone to accompany them home. It also eliminates the possible complications that can occur with any form of anesthesia. While the procedure itself can cause some cramping or gassy abdominal pain, this can be minimized through the use of carbon dioxide to inflate the colon and special techniques to advance the scope. If you want this, make sure that the gastroenterologist has experience doing unsedated colonoscopy. You don’t want to be the doctor’s first one!
Light sedation. This is rarely done. Since medications are administered, the risk of complications is present. Also, the patient will need to be accompanied home and should not do regular activities until the next day. But since the sedation is light, there is no effect on pain –the patient feels and remembers everything.
Moderate sedation. This is one of the most common forms of sedation used. The medications are usually midazolam and fentanyl – a mild sedative and a pain killer. This is a nice, safe combination, and usually causes amnesia for the procedure. The risk is if too much is given. To avoid this, it is given slowly, with appropriate monitoring. At Temple University Hospital, the doctor and a nurse are with the patient the whole time. The vast majority of patients are satisfied with this sedation.
MAC. This stands for Monitored Anesthesia Care. It is administered by an anesthesia professional who is in the room with the gastroenterologist and a nurse or technician. This is usually selected when there are concerns about the patient’s lungs, heart, or tolerance to midazolam or fentanyl. The medicine used for this type of sedation is propofol - yes, the same medicine that was abused by Michael Jackson. However, unlike Michael Jackson, the propofol for colonoscopy is given by a trained professional under constant supervision and monitoring. The depth of sedation with MAC is sometime moderate sedation, but is usually deep sedation.
General anesthesia. This is almost never used for colonoscopy. General anesthesia is usually reserved for patients with severe lung disease, unstable airways, and particularly long procedures.
So How Do I Decide What Type of Sedation I Should Get for My Colonoscopy?
It’s simple – talk to your doctor. If you are meeting with the gastroenterologist before the procedure, simply ask what type of sedation is planned. Discuss the pros and cons, and of course, your preferences and concerns. If you are scheduled for open access colonoscopy, you can call the office of the gastroenterologist prior to the procedure to see what is planned. If you want to discuss the sedation further, you should be able to speak with a nurse or doctor prior to the procedure to allay your concerns.
While we can’t make the bowel preparation more pleasant, we certainly can make the actual procedure a comfortable one
差别是300块钱
几月前做的（美国），不叫麻醉，叫Sedation，喝一小杯奶状液体，一下就睡过去了，半点感觉都没有，沉沉地睡了一觉，醒来在恢复室。消化道无后续感觉。
我觉得自己有足够的忍耐性，事实也确实如此。
腹部的，应该必须全麻