Propofol Procedural Sedation
Sedation for most of the endoscopic procedures we perform incorporates recent advances in procedural sedation that take advantage of the safety and effectiveness of the hypnotic agent propofol. Your sedation will be administered and monitored by a certified registered nurse anesthetist acting under your doctor’s supervision or an anesthesiologist physician. We encourage you to discuss the sedation plan for your procedure personally with your physician prior to your procedure.
Endoscopy without Sedation
Both upper endoscopy and colonoscopy can be performed without sedation when a patient is highly motivated to do this and is willing to bear temporary discomfort, which in some cases can be significant. Our experience is that most of our patients have a strong preference to experience as painless a procedure as possible. Unsedated endoscopy however can be provided to patients requesting it in selected cases. Please be aware that due to staffing limitations, if you request an unsedated endoscopy and the procedure is not tolerable for you it may not be possible to provide immediate backup sedation, necessitating rescheduling of your procedure for completion under sedation/anesthesia at a later date. This could incur additional charges.
Conventional Moderate Sedation
Moderate sedation has been strictly defined in government regulations that control the manner in which sedation services are provided at health care facilities in the U.S.
Conventional moderate sedation is generally achieved through the IV administration of opioids and benzodiazepine medications titrated to the point of relaxation and sleepiness, though not to the point of sleep. Patients under moderate sedation, according to its regulatory definition, must remain purposely responsive on a continuous basis to verbal or light touch stimulation.
Recent regulatory actions have been directed against the “off-label” use of medications used for procedural sedation. Physicians administering conventional moderate sedation in a manner that is approved by the FDA must observe the FDA-approved package insert, which defines the “Usual Adult Dose” in the drug label. Many patients are not adequately sedated for routine endoscopic procedures at the “Usual Adult Dose.”
While conventional moderate sedation can afford effective sedation in many cases, it may also be insufficient to allow comfortable completion of the procedure, necessitating either termination of the procedure or administration of additional medication to achieve a state of deeper sedation (which according to current federal regulations can only be administered in our facility by a CRNA or a second MD who is not performing the procedure). If you intend to avoid the costs of anesthesia services, are confident that you can complete a procedure under conventional moderate sedation, are willing to bear discomfort, and are willing to accept the expenses related to a failed procedure should your endoscopy be unsuccessful (and the costs of a rescheduled second procedure), conventional moderate sedation may be offered if your endoscopist is willing to attempt its use in your particular case.