Sedation
For most endoscopy procedures, we use MODERATE SEDATION. Most patients who have had endoscopy with adequate moderate sedation are comfortable, drowsy and do not recall having the exam performed.
When most people talk about sedation or anestheisa, their first concern is being pain free and not remembering the exam. We commonly hear "Just put me out".
There are five parts to Anesthesia.This area is confusing, because the meaning of a word used in medicine is sometimes quite different from how it is used in regular English! It is helpful to define these parts individually:
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Analgesia : (blocking pain)
blocking the conscious sensation of pain -
Hypnosis: (sleep)
unconsciousness without analgesia -
Amnesia : (not remembering)
preventing memory formation; -
Relaxation : (prevent unwanted movement)
preventing unwanted movement or muscle tone; -
Obtundation of reflexes : (block natural reflexes - for example cough, swallowing)
preventing exaggerated autonomic reflexes
Because most people are familiar with General Anesthsia, but not the different types of sedation, below we list the different types of anesthesia that are used in medicine:
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General anesthesia:
"Drug-induced loss of consciousness during which patients are not arousable, even by painful stimulation." Patients undergoing general anesthesia can often neither maintain their own airway nor breathe on their own. While usually administered with inhalational agents, general anesthesia can be achieved with intravenous agents, such as propofol. -
Deep sedation/analgesia:
"Drug-induced depression of consciousness during which patients cannot be easily aroused but respond purposefully following repeated or painful stimulation." Patients may sometimes be unable to maintain their airway and breathe on their own. Moderate sedation/analgesia or conscious sedation:
"Drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation." In this state, patients can breathe on their own and need no help maintaining an airway.Minimal sedation or anxiolysis:
"Drug-induced state during which patients respond normally to verbal commands." Though concentration, memory, and coordination may be impaired, patients need no help breathing or maintaining an airway.
For most people the term "CONSCIOUS SEDATION" suggests that you will be awake, experience pain and remember the procedure.
CONSCIOUS SEDATION is an often misunderstood term.
The goal of moderate (or conscious) sedation is for people to be sleepy (mild hypnosis), experience little if any pain (adequate analgesia), and have no memory of the procedure (amnesia).
One of the major goals of moderate sedation is to AVOID DEEP SEDATION. The main difference is that patients with DEEP SEDATION often lose their body's ability to prevent saliva or stomach contents from entering the lungs (to guard the airway). These reflexex include coughing and swallowing. If a patient enters DEEP SEDATION, the risk of complications such as aspiration, pneumonia or low oxygen level increase dramatically. We monitor the level of sedation very closely to keep patients at the level of MODERATE SEDATION.
At Boise Endoscopy Center and Meridian Endoscopy Center, we generally use a combination of two IV medications, MIDAZOLAM and FENTANYL. Both are short acting with rapid onset which allows us to get your procedure underway in a timely fashion, while minimizing the amount of time you need to wake up and recover from sedation.
Limitations of Moderate Sedation
- Every patient is an individual. Thus, your sensitivity to the sedating effects of medications and to painful stimuli can be very different from other patients
- Some patients are more sensitive to pain than others (patients with IBS or functional bowel disorders often have visceral hyperalgesia)
- Extremely tortuous anatomy can make the passage of a scope more uncomfortable. (e.g. severe diverticular disease, prior abdominal or pelvic surgeries, having a floppy or redundant colon)
- Medications which are taken chronically that act on the brain can alter your body's responsiveness to FENTANYL and VERSED. Chronic narcotics for pain, sleep aids, anti-anxiety medications, and sometimes medications used to treat a variety of psychiatric conditions can greatly affect your sensitivity to FENTANYL and VERSED
- Patients who have had traumatic life experiences (e.g. difficult or painful medical procedures, childhood physical abuse, sexual abuse or rape) often have a more difficult time with MODERATE SEDATION.
- Patients with many medical conditions may be more likely to develop complications from MODERATE SEDATION. Obstructive Sleep Apnea, serious heart or lung conditions can make the risk of decreased oxygen level or abnormal blood pressure or heart rhythyms mor likely to occur.
- Medications used around the time of MODERATE SEDATION can lower the seizure threshold.
If you have any concerns about sedation, please discuss them with our compassionate and knowledgeable nursing staff or your physician! Please be sure to specifically mention any conditions that affect you personally prior to starting sedation.