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Dr. Deepak Agrawal, a professor medicine at the division of digestive and liver diseases at University of Texas Southwestern Medical Center in Dallas and Dr. Don Rockey, who is chairman of the department of medicine at the Medical University of South Carolina in Charleston, approached doctors and nurses who do colonoscopies with three questions:
- If you were having a colonoscopy for screening purposes, which kind of anesthesia would you prefer, propofol (deep sedation), a combination of midazolam and fentanyl (moderate sedation), or no anesthesia at all?
- If you had to pay for your own procedure, how much more would you be willing to pay to be given propofol? The actual additional cost of getting propofol sedation is about $1000 to $2000 in most hospitals and clinics. Doctors and nurses in the survey were given the option of paying nothing, stated amounts up to $500, or "it doesn't matter" (that is, "I want it no matter what").
- If you prefer treatment with propofol, what are the reasons for your choice? Possible reasons for preferring propofol include not remembering anything about the event, having an additional doctor on the team, and shorter recovery time. (People who are given propofol spend about 20 minutes less in the recovery room than people who are given the older combination of midazolam and fentanyl, although discharge instructions are the same no matter which medication is used.)
Most of the 911 doctors and nurses Rockey and Agrawal surveyed reported that, for themselves, they wanted to be given propofol when they had their own colonoscopies. The most common reason given for preferring propofol is not having any memories of the event. During the procedure with propofol, the patient is actually awake, but there will usually be no conscious memory of anything that happened in the colonoscopy room. Any unpleasantness in the procedure is forgotten as soon as the procedure is over.
Doctors and nurses were not willing, however, to pay more than $200 of their own money for the procedure. That is, they thought propofol was a good idea, but it was not worth much more than 10% of what their clinics and hospitals charged, especially since the cost of the anesthesiologist is considerably greater than the cost of the time plus the cost of the procedure itself.
What about alternative medical procedures? Most other ways of examining the colon for early detection of cancer are far more expensive and really don't work as well:
- "Virtual colonoscopy" still requires insertion of a tube up the rectum, typically with little or no sedation. It can't detect smaller tumors as well as the regular colonoscopy procedure, and is primarily used for staging known cancerous tumors, seeing how advanced they are. More people complain about pain from virtual colonoscopy than the older procedure.
- Color capsule endoscopy, accomplished by swallowing a capsule containing a wireless video camera that transmits images to wearable recording device, is used for inspecting the small intestine. Conventional colonoscopy is used to examine the large intestine, also known as the colon.
- "High def" colonoscopy can detect tumors that white-light colonoscopy does not. It is deployed the same way as conventional colonoscopy.
Anesthesia Prevents Pain, Sedation Prevents Memories
If your insurance covers the cost of any kind of colonoscopy, you may be interested in whatever technique helps you get home faster and remember less. But if you are paying for the procedure out of pocket, be sure to ask about your sedation options before you go in.