Sedation for gastroscopy

Hi RHGB,

thanks for your reply - I may phone closer to the time for some reassurance, I just rang to ask about omeprazole and the stopping thereof that was not mentioned by my GP or in my appointment letter. It turns out I DO need to stop omeprazole for two weeks before the procedure and the nurse I spoke to was really nice and understading about it. Gaviscon at the ready then!

I'd have been a bit annoyed if I went through with the procedure without stoppong omerazole because no-one told me to, then havd to haev it again...at least I'm aware of the implications - that omeprazole can mask things, like the helicobacter test (which I need confirmed).

Oh well, I've been on Omeprazole (as well as others) for two years now and I saw my gastro three weeks ago and he of course knows and is doing the procedure, so it must be different for me.

Mines for oesophageal varices, so slightly different.

Don't worry about the omeprazole confusion. There's currently a controversy going on about this. Some doctors are adamant you have to stop taking it before endoscopy or any other investigation, whereas others insist it doesn't make a bit of difference. Situations like this have always been commonplace in the medical world. Believe me, it can be a nightmare for nurses having to negotiate the minefield of conflicting instructions from different consultants!

I think for your condition omeprazole won't be a problem, My GP is convinced I do not have helicobacter any more because I had two neagtive stool tests (only stopping omeprazole two days before), but then again,  I had a negative test a few months before I got a positive one, so I'm not sure about the accuracy of my post-treatment tests.

I imagine it must be tough to keep up - the nurse I spoke to said it wuld be bbest if I can stop the omeprazole, but if I can't then its not the end of the world, the helico biopsy just might come up as a false negative.

Thanks for the reply Lily,

I have read that midazolam is the sedative of choice for this procedure, and the dosage is quite similar to diazepam, but it lasts a lot longer.

Oh I didn't realise that they kept an IV in..not sure if that worries or reasures me though, I've never had one before and I find injections and blood samples icky enough. 

You are of course right that there will be medics all around and they will be monitoring me. Sometimes I'm so stressed that I forget that other people actually DO know what they are doing!

Interesting that you found the half dose made you feel panicky, that doensn't sound fun at all. At least if you have it done again you know what to expect (good or bad) so it isn't the great unknown any more. I will discuss my worries with the nurses there and maybe they can start with half dose, check me and decide whether to give more? I think that they do that sometimes...I'm such a baby about things like this, I'm weirdly convinced I'm going to stop breathing or something..

I will be sure to steer clear of benzos in the few days before the procedure even if I am freaking out because I don't want to end up with a horible mixture in my system. I take them very rarely but thinking about this gastrocopy has me thinking about reaching for the packet...

I know it is a routine thing, and it will probably be perfectly fine.

They'll either put in a re-usable line or an infusion. This is essential. If ever they needed to reverse the sedation or give you a stimulant because anything was going wrong, they could get it into your bloodstream immediately without poking around looking for a vein. And also, as you say, this gives them the opportunity to start with a smaller dose and add more if they think it's necessary.

You're right not take benzos on the day. It's OK if you take a small dose up to the day before, but if you do, be sure to tell the staff when you arrive.

As you say, it is indeed a routine thing and you will be perfectly fine!

Don't forget to come back here afterwards and tell us how you got on!

Thanks lily,

These replies and a few good posts about it not being a traumatic procedure have managed to calm me down a bit. I'll be sure to come back and let people know how it went because if there is someone else out there equally freaked out about the idea, I'd like to be able to reassure them like others be done for me

Is your appointment before the 21st?

It's July 4th. Why what happens on the 21St?

I have my endoscopy, I was kind of hoping yours was first and you could give me some feedback.

oh I'm sorry, of course I'd have done that but looks like the shoe is on the other foot!

Good luck for tomorrow

I'll let you know how it was. If I forget, just post a message here and I will automatically get a reminder about this thread. I'm in at 9:00am. I'm fine now, but it will be different in the morning.

You'll be fine! The vast majority of people come out of sedated endoscopy with no memory of it whatever.

Hope the endoscopy went well and you got some answers!

To sparkly & lily,

Well, I'm still alive. I told the gastro who did it (he was my referring gastro), that shooting me with an elephant tranquiliser gun would be his best bet, because even if I was mildy awake, I could not be responsible for my actions.

So the gastro shouted to his colleague, which sounded very like, up the doses. I had Fentanyl 50ug, Midazolam 3mg and Xylocaine (spray) 100mg. I was out like a light for the whole thing, they may of well have used GA.

So I can't remember anything and I don't have a sore throat either and best of all my eosophageal varices have gone,just a bit of gastritis and a slight increase in my omeprazole dosage for six weeks.

Fantastic news! Especially about the oesophageal varices disappearing. I was a bit concerned when I heard that was your problem. Gastritis is nothing much to worry about, as long as you watch your diet a bit and keep taking the tablets.

'I was a bit concerned when I heard that was your problem'

Just one of many. I had an abdomen ultrasound on Saturday and I queried the radiologist, because she was taking a long time and I said, it's bad news isn't it, you know why I'm here and I know why I'm here, so don't beat about the bush.

And her words were, your liver is not brilliant, but no worse than it was two years ago, but what took the time is I was having difficulty in finding something - you have gallstones, it looks like they missed that last time.

So I'm kinda used to that sort of news.

Gallstones, eh? That's a bit of a bummer, but not too serious - especially these days, when they mostly do the job via keyhole surgery. Back in my nursing days this was major surgery involving quite a lot of post-op pain and a long stay in hospital. It's a relatively minor procedure now. And they might well decide you don't need an op anyway. Gallstones don't always cause problems.

And at least your liver is stable.

Frankly, if I had to choose between having oesophageal varices or gallstones I'd have no difficulty making my mind up!

That is really great news, well done for getting through it and an improved diagnosis to boot, that's great. Interesting that they combine fentanyl and midazolam, and also interesting that those doses were enough to knock you out! Thanks so much for coming back and reporting.

The radiologist seemed to think that because they are not causing me any pain, that the gastro will probably say, just leave them alone.

'Interesting that they combine fentanyl and midazolam, and also interesting that those doses were enough to knock you out!'

I have no knowledge of these drugs because last time I had a gastroscopy it was as an inpatient under GA. I will also say that I'm 6'2" and built like a rugby player, but they still knocked me out like a light.

Good luck in a couple of week's time.

 

Hi, it will be a Doctor giving the IV sedatives. They will start by giving a small amount and then see how you react. Then they'll give a little more. It's called titrating the drug to the response. Hope this helps. They use midazolam because it causes amnesia. so hopefully you won't be able to remember the procedure.

But are they affecting your liver function test blood results, ie causing obstructive jaundice? Guess it's difficult for them to tell with your liver problems. When my Mum had gallstones, she had a couple of episodes of quite bad pain about 3 months apart, but then she showed me her red palms and said her urine had been bright yellow. Her LFTs were off the map, and GP referred her to GI, but in the 3 month wait, never bothered to get her back to check her LFTs. GI said she should have been an urgent referral if they hadn't reverted to normal. GP's eh.

awesome, I was hoping they would titrate and not have a one-size-fits-all strategy because I'm 5'6 and built like a ballerina so I don't think I'd need the same dose as RHGB but who knows.

RHGB you say you don't remember the procedure, what is the first thing afterwards that you do remember? i.e. how long is your amnesia?

'But are they affecting your liver function test blood results, ie causing obstructive jaundice?'

The answer to that is I don't know. Whilst I have a good knowledge about most things that have happened to me, the gallstones were new to me, having been informed of it Saturday lunchtime, and then only because I knew how to 'coach' the info out of the radiologist. I need to do my research.

I doubt that I will be told much in the gastro's report, but I have gotten used to this over the last two years. I always now ask for a copy of the report to my GP along with the original blood tests, so I can interpret them for myself (I am on first name terms with the secretary and just email her).

I have read your reply in the other thread and I will respond later when I get a moment.

I remember the gastro applying the sedative via syringe into the cannula, just after they had put on the mouth guard.

The next thing was the trolley being wheeled out of the op room - I think it was the motion that woke me up. Then pushed into the recovery area, where I laid for about one minute orientating myself and then got up and started walking around.

RHGB, I'd just like to say your approach really heartens me. You seem to have cracked the problem, mentioned in one of my earlier posts today, of establishing a partnership with your medical team, rather than the parent-child model that seems to be the norm. I'm guessing this wasn't as easy in the NHS environment as in the more patient-oriented European models. I worked in the NHS for 10 years and had to contend with it for the 20 years of my parents' ageing process, so I have a pretty good knowledge of the ethos.

I'm not exclusively demonising the NHS here, by the way. Even in the more liberal Continental systems, doctors and other medical professionals can still become arrogant and dismissive if not politely reminded from time to time that they're dealing with a person rather than a disease.

I think others should take their cue from you, and insist on being treated as partners in their treatment.

Well, I have several attributes that many others do not have that allows me to be able to talk on 'par' with any medical professional. Sadly that is not the case for most and the parent-child relationship is the norm.

I saw enough bad decisions whilst in hospital to know they are not quite as omnipitent as they think they are. That is not to say I don't have tremendous respect for them, I just expect a little respect back.

On your other post, yes now the statins seem to have been kicked into the long grass, the switch has been made to HBP medication.

I had to smile to myself at my GP surgery last year on my 12 month check up from my stroke. They wanted to add statins and aspirin to my medications. I thought to myself, hang on, I had a bleed on the brain not a TIA (clot) why the hell are you trying to put me on a thinner, do you want me to have another stroke.

I never said anything other than no thanks. Statins next up. It was the usual we put anyone on statins in the at risk category. I said so what are the parameters? Well the NHS guidelines are to aim for 5.0 or less. So what am I? You're 4.9 now, you were 5.7 when you were in hospital.

You can kind of guess what my mind is thinking. So we like to be on the safe side even though you're under. Well, I'll say no for now, and try and reduce my cholesterol, because I think that would be better than taking statins. Six months later, I'm back in for a check up and I bring up the cholesterol level, so what is the current reading? You are 4.2.

Funny that, they've never mentioned it since. Medication before rectification, how stupid is that.

 

Ah so you were only 'out' for the procedure then really. I wasn't sure if the amnesia lasted all day!

Good luck on Monday, hope all goes well. Enjoy your tea and biscuits afterwards.

Thanks! I expect I'll be fine once I get to the hospital. I've got my anxiety therapist's mobile number in case I have a wobble immediately before!

Hi Sparkly,

Be sure and let us know how it went, won't you?

  I was scheduled for one today I went to the Hospital and got an Iv set up. I think about 10 min later I started to panic bad! They said they were going to give Propofol. I don't like drugs. I don't like to be unconscious. I told the Nurse i was done and wanted to leave. She was nice and took the needle out and i got dressed and left. i rather be awake and do more natural approach.

Sorry to hear about that Thomas. Didn't your doctor discuss the options with you before starting? Lots of people opt to do it with just local anaesthesia (numbing throat spray).

On the technical side, the drugs they use don't actually render you unconscious, they just take away all memory of the procedure - which I suppose amounts to the same thing from the patient's point of view. Well, that's the theory anyway, but some of us come out of it remembering the whole thing anyway.

Better luck next time!

Yea..But when i got to the Hospital the anesthesiologist said something different. He also seemed really weird. He also kept going on how people have cool dreams. I rather the more natural awake Approach.I don't care if i gag some.