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Anesthesia

Can I Get a Colonoscopy Without Sedation?

08/11/2009

Question:

I`m 55 and my father died of colon cancer at 40; I was supposed to get screened at 40 but didn`t for one reason or another..basically because I had very little medical treatment in the last 15 years and when I did I failed to mention my family history. For the last month I have started to have bleeding, diarrhea then constipation which I tried to ignore, but finally found a doctor and got a physical exam..everything was o.k. except for a lot of weight loss and the bleeding. The doctor went ballistic (in a nice way) when I mentioned my family history and told me to get a colonoscopy ASAP. The only problem is that I have problems with sedation and couldn`t find a local doc to do the unsedated exam; they all acted like I was crazy when I tried to schedule the unsedated test. I called the a major medical center who said that the unsedated exam was no problem, it`s a long drive but possible. The symptoms have me scared (my fault for waiting so long); I was wondering if there was anything that I could do to try and convince the local docs who refused to do the unsedated test (most said it takes longer and delays them too much) rather than make a very long trip? From what I have read, a lot of people seem to have problems with Versed like I do and I`m lucky enough to be allergic to eggs so diprivan is out. Would it be out of line to offer to pay extra for an unsedated exam locally to see if they would consider doing it? I don`t have much experience with doctors and do not want to insult anyone. Thanks.

Answer:

Like your doctor, I must urge you to have a colonoscopy without delay.

You might be able to find a doctor closer to home who is willing to do the exam without sedation - but you are introducing further delay. Your current symptoms and family history of colon cancer put you at high risk of having a serious problem that needs to be diagnosed and treated now. I would imagine this must be making you fairly anxious.

Although doctors are sometimes negotiable on price, your tactic of offering to pay extra for an unsedated colonoscopy is not likely to be helpful. Just because colonoscopies can be done without sedation doesn't mean that they should be done this way. There is definitely a higher failure rate without sedation - i.e. the procedure has to be abandoned and rescheduled with sedation. So your local doctors could simply be uncomfortable with having to do the procedure in a way that is unfamiliar to them and that might lead to failure. Offering more money is unlikely to be persuasive and, as you are guessing, could even insult them.

Diprivan (propofol) in its original formulation contained duck egg lecithin so in theory those with egg allergy should not be given propofol. In practice however this is seldom a problem except in cases of confirmed anaphylaxis ("shock") to the same egg component as is contained in propofol. If you prefer not to travel to so far away, you could be evaluated by one of the local anesthesiologists with special attention to your allergy history, who may decide that it is not unsafe to try propofol, or may offer you alternative sedative medications. You don't mention what your problem with Versed (midazolam) has been, but it should be noted that although some people report problems and tell their stories on the internet, millions of Americans have received midazolam sedation for a variety of procedures without ill-effect.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University