Colonoscopy: anaesthetic or Entonox?

[Shortfatandangry]

Just that really. Not sure which to go with, the anaesthetic is Fentynl I believe, which I don't like the thought of but everyone I've spoken to says gas and air isn't enough.

I had precisely one puff on gas and air and didn't feel like i needed another one. They took about 6-8 biopsies too. I found it completely fine and enjoyed watching on the camera.

It's the same in Australia

I had polyps removed didn't feel a thing I'm assuming there is no nerve endings or anything there

I also enjoyed watching.

GA is complete overkill. I've had 2 with sedation. I was wondering about trying any subsequent session with gas and air. Quite like the idea of the cannula just in case.

I had a cannula in i think they have to anyway for emergency purposes.

Thanks for the response. That's interesting. I had assumed that one reason that they do them under GA was because of this.

Why do you consider GA to be overkill? It's easy and safe. I was dressed and out the door ten minutes after coming round. I went home and took a nap and then felt absolutely fine. I was glad not to have any recollection of anything that took place in the room!

Sedation for me every time it really worked well.
hardest part was getting home after organising a lift

the main sensation that bowels are able to translate into pain that's relevant during a colonoscopy is stretch/distension...and that's why colonoscopy can be painful for some people because the gas used to insufflate +/- poking to get the scope round the bends stretches the bowel walls. Guts don't tend to respond to an incision in the same way that skin on your arm or leg would. This is why you can do operations like hernia repairs or even appendicectomies if you're really desperate with just local anaesthetic to the superficial layers.

GA isn't always safe or easy. You shouldn't be up and out within 10 mins, and that they got away with you doing that does not necessarily mean they did a good job. Not everything that happens in America is better (for the patient... it is of course better for the providers if they can charge you for it though!) DOI: (UK) anaesthetist.

OK - of course it's not always safe and easy. There are risks associated with any procedure. I should have said it's routine and almost always without incident.

Curious why you think I shouldn't have been able to leave 10 minutes after coming around from the anesthesia? I had had some apple juice, was alert, and able to move around and dress myself.

Because the risks of a GA are low but not zero. If i don't need to be unconscious or immobile I would prefer to use the lowest level of anaesthesia needed for the procedure.

And it's an interesting procedure.

So, I had an epidural for the childbirth that was a struggle and gas and air for the subsequent births - including the who came out back to back.

I didn't even leave that quick and I didn't have anything. In the past when iv had ga for operations it's been a whole day thing if not staying over. I don't understand how you can be out the hospital 10 minutes after waking up from GA. And yes I do think GA is massively overkill.

I had one a couple of months ago with just gas and air as was looking after my little one alone that evening, it was very uncomfortable in parts and a few parts where I was really struggling but I wouldn’t be too bothered if I had to do the same again.
He had me in all sorts of positions as apparently I have a very long a twisty colon🤣 which I’m sure didn’t help.

It depends if it's the lower gut or all the way up into the small intestine. Large intestine, in the hospitals here, they've stopped offering anything and tbh, it was a lot less unpleasant than a camera down the throat. The move from the large to the small intestine can be painful, but entonox should be enough for that. They'll give you more if you find it particularly painful. It's safer without and you can go home pretty soon after. Fwiw, OP, I've had three when I had a cancer scare, and the prep was no fun, but the actual procedure was OK - I was dreading it, but it really wasn't bad. After the first one, I wasn't worried any more.

Iv heard this a lot i think i have a really good shaped colon as iv never had to move from laying on my left hand side which is perhaps why mine didn't hurt. I also got lots of complements on how clean my colon was i felt very proud 🦸‍♀️🤣🤣🤣

I suspect you're talking about having received deep sedation with propofol rather than GA (we affectionally call it 'anaesthesia without airway control'). Either way, it isn't that uncommon to see side effects in the recovery room some time after 'waking'. Protocols here usually suggest that after procedural sedation patients should remain onsite and be monitored for 1-2 hrs post procedure. A very basic google suggests the US standard is 30-45 mins. Either way, 10 mins is not enough and I'm surprised that in such a litigious country any HCP would be up for chancing it that soon. The main risk with propofol in this context is that after a good clear out with bowel prep, skipping breakfast and then having a profound sedative that comes with some pretty funky cardiovascular side effects, you'll be shipping off someone at significant risk of hypotension and collapse. Deep sedation is also associated with an increased risk of aspiration and an associated pneumonitis/pneumonia and propofol is a very profound inhibitor of airway reflexes so patients are unlikely to cough any acid/stomach contents that come up... it may only declare itself to have happened in the recovery period (and yes, even 1-2 hours may not be long enough to spot it, but at least you can show you've tried).

If they're using GA with proper airway control then just occasionally you see complications from airway instrumentation. It's also unlikely that a single drug will have been used and polypharmacy comes with more side effects.

If they're talking about doing sedation with other drug combos (a benzo and opioid for example) then the drugs last a bit longer and can cause variable levels of respiratory/airway depression that can go on for a while. If they're using reversal agents to counteract a benzo/opioid, the reversal drugs don't last as long as the initial drugs so a relapse of sedation may occur.

all of the above is assuming a fit and healthy, normal weight patient... which is increasingly uncommon!

These things of course don't include any reference to the procedure for which the sedation/GA is being done. Colonoscopy under deep sedation comes with a higher risk of bowel perforation. Colonoscopy with biopsies comes with some risk of bleeding... which may not declare itself in 10 minutes and will make a right old mess of your car seat if you're on the way home!

I’ve had one with just gas and air. It was painful but bearable.

I got the “very clean colon” comment as well 🤣 I was so proud of myself.

God yes, you’re lucky! I had to switch to my right side, then onto my stomach!! I got tangled in the tube thing, and all of this whilst wearing what essentially amount to paper arseless shorts, kissed goodbye to my dignity that day for sure.

The one size fits all paper shorts 🤣🤣🤣 yeah you definitely don't leave with any dignity I honestly don't know what was worse when they first start and everyone sees your bum hole on the big screen or when a nurse was making small talk with me and recognised me from a local shop I worked in

🤣🤣🤣 oh no!!! Your experience definitely sounds worse than mine!
Thank God I missed my bum hole in HD, I was spared that delight.

I was laughing my head off at the shorts, I took a photo in the mirror from behind to show a few of the girls at work who I knew would appreciate my distress😂

Its nice to find the humour in these things.

I'm in the US and I had it done under sedation - I was aware of where I was, and watched it happen on the screen. It was a weirdly nice experience.

I was told it was general anesthesia. I was awake going into the operating room and then given the medication which put me to sleep, and then I don't remember anything else until I was in the recovery room with the nurses waking me up saying "it's over". Would deep sedation really have knocked me out to that extent, and if so, what's the difference between that and GA?

I didn't time it, so it may not have been exactly 10 minutes, but it certainly wasn't longer than 30 minutes. I was woken up, given a drink of apple juice, and then got dressed and they wheeled me out to my husband's waiting car.

I have had a couple of surgeries in the past few years - knee and ankle - and they were definitely done under GA, and the experience was pretty much the same. They don't seem to think there is any reason to keep you once you're awake and aware, and vital signs look good, and as you said it's so litigious here that they would if they thought there was anything other than a very remote chance that there could be serious side effects. Obviously you're discharged with instructions to follow, and told to call if there are any issues, and afterwards either the surgeon or one of his staff has called me later in the evening to check that everything is ok.

Interesting. I assumed GA was standard here. My husband had GA for his as well - different doctor and different medical group.

I had gas and air and it was very painful. Never again. Was told afterward "Oh its often harder if you have had hysterectomy because everything has moved". Pity they didn't tell me that before!