If you have a preference regarding your sedation it is important to convey your feelings about this to the gastroenterologist who will be performing your procedure and who can fully discuss the management options which may best meet your needs.
Propofol Procedural Sedation
Offered at the Southwest Endoscopy Center and Mercy Regional Medical Center
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 (at Southwest Endoscopy Center) or an anesthesiologist physician (at Mercy Regional Medical Center). We encourage you to discuss the sedation plan for your procedure personally with your physician prior to your procedure.
Propofol-based sedation is the type of sedation used most frequently in the United States for screening colonoscopy (based on Medicare data, 2013).
See our Sedation/Anesthesia FAQs
Endoscopy without Sedation
Offered at the Southwest Endoscopy Center and Mercy Regional Medical Center
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.
See our Sedation/Anesthesia FAQs
Conventional Moderate Sedation
Offered on patient request at the Southwest Endoscopy Center
We made the decision to discontinue the routine use of conventional moderate sedation (also called conscious sedation) in 2006, due to limitations in the effectiveness and adequacy of this technique for the procedures that we commonly perform. 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 United States. 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.
Please understand that our staffing limitations may not permit a procedure that is scheduled to be performed with moderate sedation to immediately be converted to an "anesthesia" case. Failed sedation cases will be rescheduled as expeditiously as possible (potentially to another day) when an anesthesia provider is available to administer deep sedation/anesthesia, for which additional charges will be incurred.
Consent forms for Procedures with Conventional Moderate Sedation
Anesthesiologist Services
Offered at Mercy Regional Medical Center
In some cases, based on the medical complexity of your history, physical characteristics suggesting an increased risk for complications related to sedation, or the anticipated complexity of the planned procedure, your gastroenterologist may recommend that an anesthesiologist (a doctor specializing in the deliver of anesthesia care) provide sedation/anesthesia services in a hospital outpatient setting. You may also request sedation by an anesthesiologist as an alternative to having a CRNA provide your sedation/anesthesia.
Anesthesia services are professional services rendered by physicians who are highly trained and experienced specialists in the field of anesthesiology and are not directly affiliated with Digestive Health. Charges for anesthesia services are separate from professional charges for endoscopy services rendered by Digestive Health's physicians. These charges are generally covered by health insurance policy in accordance with the insurance contract, though some carriers may only provide for anesthesia services for endoscopy in special medical situations.
See our Sedation/Anesthesia FAQs
Your doctor is pleased to discuss sedation options in more detail directly with you prior to the scheduling of your procedure.
Special Concerns
Breastfeeding mothers undergoing sedation/anesthesia
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