Propofol and Vasovagal Response

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I just had a colonoscopy and was clear about no sedation - to everyone. When I reached doctor and we discussed it again, he read through my notes and remembered my telling him about passing out during IBS episodes when the spasms of my intestines (or lower bowel or colon or whatever) trigger the vagus nerve. Not every time, but it happens. He essentially refused to perform the colonoscopy without sedation. He said people have had to be resuscitated during colonoscopies and he didn’t want me to die and get sued.  I ultimately agreed because I was put in such a railroaded position. He apologized for agreeing earlier but that he neglected to read my chart and see these notes.

After getting home and doing some research, I’ve come to the conclusion that propofol sedation doesn’t prevent the spasming of the colon and people still have had vasovagal responses during colonoscopies. It doesn’t appear to ‘sedate’ the colon at all so why did he insist on the sedation?! Am I correct in my assertion about it not calming the colon? 

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  • Posted

    Hi

    As far as I'm aware sedation is given to generally calm the patient down who is having the colonoscopy, I've never heard that it calms the colon down. Thing is, by the end of your bowel preparation there won't be anything left inside you so the colon will be in a relaxed state anyway, plus by the laxative would have worn off by then. It's probably a very basic theory I'm expressing here so I do apologise if I'm wrong in my assumption, but that's the way I see it.

    Why he insisted on sedation I really can't comment on, but many people suffer IBS that have colonoscopies with or without sedation, and there is a potential risk, as with any medical procedure, of complications, but the risks are low and generally colonoscopies are performed without complications. I've been diagnosed with IBS and had two colonoscopies, both with sedation, and they went really well, much preferred the actual colonoscopy to the bowel preparation, probably because of sedation.

    Don't know if any of that info helps, probably not, but I thought I'd share my thoughts anyway.

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    • Posted

      Colonoscopies are safe, I agree. The riskiest part of any procedure is the anesthesia. I didn’t want anesthesia and I wanted to watch the colonoscopy. The doctor’s rationale was unjustified and wrong. I talked to the follow up nurse who just called me and she confirmed even while under sedation, a vagal response is still possible. 

      It’s not whether propofol is safe or not, it’s about respecting a patient’s wishes. The doctor went on about how painful colonoscopies are yet no sedation is practiced in many countries. It’s not a walk in the park but can be tolerated and the request should be honored. 

      I’m putting in a call to his office to discuss this further with him. 

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    • Posted

      I agree with you in respect of patients wishes. I've expressly asked for no Buscopan for a small bowel MRI I'm due to have due to previous bad reactions to the medication. I don't know where you are based, but in the UK, Buscopan is administered routinely by the NHS to get clearer images of the small bowel by slowing the bowel action down. When I told them that I didn't want to be given it due to past complications they told me they would have to wait and see. Because of this I enquired about a small bowel MRI scan under a private scheme, expressing my concerns over Buscopan. The private healthcare consultant told me that it is entirely my choice if I want it or not, and that even if I wasn't administered it, they would still be able to get clear images. He then told me the NHS like to follow their procedure so that the results they get from the scan are as good as they can get first time, therefore eliminating the need for further MRI scans due to unclear images.

      It does seem odd that some healthcare professionals will insist on following their procedure, ignoring the wishes of the patient who obviously has valid reasons for not wanting certain parts of the whole procedure.

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  • Posted

    Good morning:

    Propofol, is one of the doctors favorite drugs as it has a quick onset & most important to the medical community, it has amnesia effects so the patient doesn't remember. It doesn't have the memory loss effect of say Versed or Midazolam its generic but none the less it will cause the patient to forget.

    It's hard in the states to get a colonoscopy without sedation. You have to spend some time looking.

    Also, the pediatric colonoscope is easier on the adult patient because its smaller if you can find someone trained in its use.

    Regards,

    Raffie

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  • Posted

    To wrap up my situation --  I spoke with the gastroenterologist regarding the propofol and a vasovagal response.  He said the chances are "greatly reduced" with propofol but not eliminated entirely. I was under the impression he was stating it eliminated the possibility. It wasn't a productive discussion at all. He sounded perturbed I would ask and actually said if he had known I was "hanging on his every word" when expressing this concern to me, then he would have been more thorough in his explanation.  Yeah, as an educated, discerning, and precise individual, I would expect a complete and thorough explanation from a doctor.  One would hope they would strive to be exacting in their explanations as well.  (insert eyeball roll here). Apparently I should have just shut up and trusted everything he said with no detailed explanation whatsoever. This is what happens to doctors when they've been doing this too long and become just a little too cocky about their abilities and coming across too many uninformed, low IQ patients. They talk to all the patients like they're idiots. 

    I'm not entirely convinced it greatly reduces the instance of a vasovagal response but I don't feel like taking a survey of opinions from other gastroenterologists.  What additionally annoyed me was his insistence on how "painful" the procedure is. At best he should probably say it affects people differently and one can never predict any person's pain threshold or level of discomfort.  I had children without an epidural, so let's not assume you know my pain threshold. 

     

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    • Posted

      Hi Michigan:

      The most uncomfortable portions of the colonoscopy are when the scope turns a corner which if I remember correctly is three times. An experienced technician and mitigate this discomfort.

      The main reasons the American healthcare system forces patients to take the drugs are;

      1. Patient compliance.

      2. MONEY. Using the drugs, gives them a bigger payday.

      Regards,

      Raffie

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