Colonoscopy using propofol for "enhanced sedation"?

[StJills360]

Hi - has anyone managed to successfully request this from the NHS?

I have been called for a colonoscopy following a positive FIT test - they seem to be offering only 3 choices to manage my anxiety of the process: nothing, gas and air or midazolam/fentanyl. I have avoided anything invasive medically for many years (inc. the dentist) due to extreme anxiety so wish to be unaware of the process, hence the deeper sedation request. According the BCSP guidelines, a small majority of patients need enhanced sedation using propofol and the BCSP provider should make reasonable efforts to provide this. It all seems to hinge around whether an anaesthetist is present or not as propofol cannot be administered by the endoscopist.

I don't feel I can proceed with the test with what they are offering so will cancel the screening appointment. As I have no symptoms, I feel there is no rush here and can see if I can find a private service.

I know the vast majority of people are fine with what's being offered - but unfortunately, feedback from several colleagues has highlighted that when this doesn't work, the lack of an anaesthetist means you just have to grin and bear it as they can't give you anything else. I don't want to take this risk, especially as to get me into the room into the first place will be challenging enough (hope the GP can help with that). You'd have thought with the modern medicines available that having mentally endure a procedure a process that documents how well it was "tolerated" was a thing of the past.

I fully understand the importance of this and the risk if I don't proceed - but the primitive part of my brain wont let me. It is worrying my DH (he has found this a breeze by comparison) but this has not changed my decision.

Hopefully someone else has experienced the same and can offer some advice!

Go private

Propofol for endoscopies is only used in very specific circumstances, I.e. learning disabilities

Why do you not feel like midazolam and fentanyl won’t be enough? They’re pretty hard hitting drugs.

Fine to go private, but best not to leave it too long.

No symptoms doesn't mean no polyps.

Thanks, I'll have to private - just need to track down someone offering this service (most just claim they are better - but the same protocols apply). I am still not sure I could do it, but in theory it should be easier (I believe I suffer from Tomophobia as it's anything medical that triggers the anxiety really).

The NHS offering could be enough - but my mother and a couple of colleagues would disagree unfortunately. What's offered does differ globally it seems.

Hope you easily find someone you have confidence in.

Sending good wishes.

I had midazolam, fentanyl and buscopan. Midazolam made me generally unaware of what was happening. I remember only tiny bits of the procedure. Have you ever had midazolam?

I've not tried it no - but I have Diazepam and it did nothing for me - so my confidence in another benzo isn't great exp. considering first-hand accounts - even my DH remembers everything that happened. If was sure 100% it would work I could possibly proceed but I can't take that risk. The Diazepam was meant to calm me before the dentist - but as it didn't work I had to cancel. Apparently benzos are less effective the more stressed you are - which seems counter productive. Even sitting in the waiting room with my DH was bad enough and I was only the driver!

Diazepam and midazolam are nothing like each other.
If that’s what’s stopping you, then I would suggest trying it.
you can always stop the proceedure if you wish

If it helps, I was on diazepam for back pain plus oramorph and working FT (I'm a redhead, it takes a lot to knock me out)

Before an operation I was so terrified they gave me midazolam and it was blissful. The worry went away, I felt drunk but happy laughing drunk, not sick or anything. Couldn't have worked if you offered me a million pounds

Midazolam and diazepam are not even remotely similar. Midazolam was glorious; I went off to sleep immediately and didn't have a clue what was going on. All I remember is someone at the end of the procedure pointing to the screen and trying to get me interested in looking at my colon (which I'd normally enjoy but couldn't have cared less about in that moment). Then I had the best nap of my life once I got home. I think you'd be absolutely fine with it OP.

I’ve just had prolapse surgery, with a spinal anaesthetic. I was very anxious about being awake during this procedure. I was given midazolam and I remember absolutely nothing about the operation.

Thanks - I found a provider for about 2.5k so I hope they can help.

Thanks for the supportive messages - but reading other folks experiences on MN, there is a chance of it not working (and under sedation, the endoscopist is under thier discretion about stopping when a patient asks). I would far prefer what my children and pets experience - ie nothing.

Thank you all for sharing your positive experiences though.

I had fentanyl for mine and have zero memory of it.

As someone who has had many colonoscopies (and ultimately a bowel cancer diagnosis) in another country where Propofol is standard, I think the NHS approach is somewhat barbaric.

I have no awareness or recall after my colonoscopies. I have had fentanyl and midazolam for a liver biopsy which left me relaxed and with my eyes closed but I was aware of what was happening and could hear what was happening around me. It was fine for that procedure but I wouldn’t choose that level of sedation for a colonoscopy.

I’m sorry you’ve had to source a private option but I would urge you to have the procedure as I had no bowel symptoms before my cancer diagnosis.

They do entire breast implant surgeries, face lifts and tummy tucks under twilight sedation (fent/midaz) these days.

IV Midazolam is so much stronger than a diazepam tablet.

I have to agree, I find colonoscopies painful, I have crohn's and it hurts. They're pushing the scope up one end and I'm crawling off the bed at the other. To me it feels red raw. Not nearly enough sedation.

I refused a colonoscopy because of anxiety and all sorts of reasons really. I got an abdominal CT scan instead, recommended by my GP. I still had to battle with the consultant over getting it as colonoscopy is the 'gold standard' but as I agreed that a CT scan might miss something, it was allowed so I did that instead.

In my health board, they do offer propofol for procedures as my DD was given it after a failed sedation attempt which was very traumatic for her. She did have to wait for a further year for her procedure before she got to the top of the heavy sedation list though. I think it's worth asking your health board.

I've also had a procedure with midazolam and like my daughter, I was awake for every second of my gastroscopy. It wasn't the worst thing I have ever done but I totally get why you don't want the lighter sedation OP

I’ve had fentanyl and midazolam for a different procedure and it was not sufficient- I don’t remember anything but I was told they were unable to complete the procedure.

I can recommend a private clinic that will offer propofol if you wish ?

I had to have an endoscopy and colonoscopy one after the other, in the same session so wanted to be knocked out for it and had to go private for the heavy sedation.
It was 100% worth it.

I have annual colonoscopies. To be perfectly honest the most traumatic part of the experience is the bowel prep you have to take beforehand. And this is coming from someone who faints every time I'm in a hospital/dentist etc. and not even when I'm the patient!

A mixed range of responses - many thanks for your time!

The Tomophobia means I can't even contemplate committing in the first place, let alone getting in the room and giving it a try. So I am trying to load the dice in my favour.

Would those that went private with enhanced sedation be willing to share who they used? The one I thought I'd found turned out to be just offering the same (based on feedback) - saves me the £200 consultation fee to be told the same.

IV midazolam is in a different league to oral diazepam- seriously its game a changer.
combined with fentanyl (!) and I would imagine it would be highly effective for nearly everyone without a history of substance misuse.

I can say after seeing my mum the most relaxed I've ever seen her after she had fentanyl I personally wouldn't discount that option. She said she couldn't remember a thing apart from singing "ain't no mountain high enough" 🤔

Good luck op am sure its all OK i know lots of people who have had positive tests and its been polyps x

Thanks Megifer. My first hurdle is if/how to get the further test actually done. I am blocking out what might lie beyond that. I don't really want a very traumatic experience (for me) getting hear about yet more traumatic things or worse to come. So like I say I am trying to load the dice....