Sedation determines your comfort during and after Endoscopy. All my endoscopies are done under sedation with monitoring for the best comfort and patient safety.
WHAT ARE MY CHOICES OF SEDATION FOR ENDOSCOPY?
The following are the list of sedation choices available:
- Local Anaesthesia
- Conscious Sedation
- Deep Sedation
- General Anaesthesia
| Local Anaesthesia | Conscious Sedation | DeepSedation | General Anaesthesia | |
| Endoscopy Comfort | Very Uncomfortable | Minimal to No Discomfort | No Discomfort | No Discomfort |
| Procedure Duration | 5 minutes | 5-10 minutes | 20-30 minutes | 2-3 hours |
| Area | Daycare Endoscopy | Operating Theatre | ||
| Risk of Sedation Related Complications | Lowest | Low | Medium | Highest |
| How it work? | I only numb your throat. | I administer a sedative and painkiller. | The anaesthetist administers Propofol. | The anaesthetist Intubates you and maintains anaesthesia. |
| Medications Used | Lignocaine Spray | 1. Midazolam 2. Fentanyl or Pethidine | 1. Propofol | As per anaesthetist |
| Pros | 1. Very fast and no need for sedation. 2. Can drive and return to work. | 1. Comfortable enough for most people. | 1. Most comfortable as you are in deep sleep. | 1. Excellent choice in emergencies or severe bleeding. |
| Cons | 1.I had it before, it is uncomfortable | 1. Cannot drive and make important decisions for 24 hours. | 1. Costs more.2. Require anaesthetist.3. Higher risk | 1. It is performed in OT.2. Highest risk among all choices |
What is my personal preference?
I prefer to perform Endoscopy under Conscious Sedation as most patients report not recalling the procedure. I further optimize endoscopic comfort by using Carbon Dioxide and Endoscopic maneuvers to reduce patient discomfort such as scope shortening or cap assisted endoscopy. The combination is often sufficient for a very comfortable endoscopy for patients.
What happens if the patient is extremely uncomfortable during the procedure or in severe pain?
This occasionally happens, usually in patients with Inflammatory Bowel Disease (IBD) such as Ulcerative Colitis and Crohn’s Disease where the inflamed bowel causes severe pain or prolonged procedure might cause the drugs to wear off. In these instances, the patient might prefer Deep Sedation using Propofol for their Endoscopy straightaway as compared to Conscious Sedation.
