A Quick Look at Sedation for a Colonoscopy
/Colonoscopies are important screening tools that are used to detect colorectal cancer and diagnose various bowel disorders including inflammatory bowel disease. Every year around one million colonoscopies are performed in Canada, making them common medical procedures. However, while they are very effective and reliable tests, they aren’t most people’s idea of a fun time. Thankfully, sedation can make having a colonoscopy a fairly comfortable and painless procedure.
Depending on where you receive your colonoscopy, your sedation may be administered by one of our members, an Ontario anesthesiologist. We are highly trained doctors skilled in making this procedure as comfortable as possible.
As experts in administering sedation for colonoscopy, we’ve put together this post to provide some clarity around your or your loved one’s upcoming colonoscopy sedation journey.
What kind of sedation can I expect to receive for my colonoscopy and how will it feel?
There are different types of sedation available for a colonoscopy and what you are offered may depend on your health, your preferences and where you’re receiving your colonoscopy, a procedure that is sometimes called a “scope.”
In many Ontario hospitals or specialized clinics, you may receive what we call “deep sedation.” As the name suggests, it’s a form of anesthesia that will heavily sedate you. This is done using intravenously administered medicines and usually involves a common anesthetic called propofol. Sometimes additional anxiety-reducing medication, such as midazolam, may also be administered.
While the exact process can vary, your sedation will usually begin with you wearing a hospital gown and in the same room, and bed, as where you’ll receive your colonoscopy. Once in bed, a nurse will insert an IV into a vein in the back of your hand or arm. While this can initially feel a bit uncomfortable, once the IV is inserted it is far less noticeable and you likely won’t be aware of it once the medication is turned on.
You will likely next speak first with your endoscopist—the physician administering your scope—who will answer any questions you have and obtain your consent for the procedure. Then, once all monitors and other equipment have been checked, you will be instructed to position yourself a specific way on the bed.
Deep sedation is most often administered by an anesthesiologist. In Ontario, anesthesiologists are medical doctors who have five to seven years of specialist training following medical school. You can learn more about our profession here. We know how to work with your colonoscopy team to help make this procedure as comfortable and safe as possible.
In smaller centers, a family practice anesthetist (FP-A) may administer your sedation. FP-As are family doctors who have received additional training in specific aspects of anesthesia, including how to deliver deep sedation.
Your anesthesiologist or FP-A will introduce themselves and obtain your full medical, surgical and anesthetic history, to ensure that they can provide you with safe and comfortable care. They will then briefly explain what sedation is appropriate for you and what you can expect in terms of recovery.
Once everyone, including you, is ready, your anesthetics will be administered through your IV. You should feel the impact of the medication within a minute or two. You may feel a warm sensation as the medication enters your bloodstream; this is completely normal.
Most patients who receive deep sedation sleep through their procedure and have little-to-no memory of it. However, some people maintain more awareness, including memories. This is generally intentional due to a medical history that requires a lighter level of sedation and helps to ensure safe recovery both in the clinical setting and during the recovery period at home. Regardless of your awareness level, you should not feel pain or serious discomfort during your procedure.
Once your health-care team is confident that the sedation is working as intended, your procedure will begin. During this time, your vitals including your heart rate, blood pressure, oxygen saturation, ECG and breathing, as well as your level of consciousness, will all be closely monitored. Unlike with general anesthesia, you will be breathing on your own. While you will be wearing an oxygen mask, a breathing tube is not usually needed (as you see in many medical shows).
Complications due to deep sedation are extremely rare but if something does go wrong, your medical team will work together to ensure your safety and make all necessary adjustments to minimize any potential complications. Rest assured that whether you’re scoped in a hospital or a clinic, all necessary medications and equipment, including the tools needed to support your breathing, are available and rechecked daily and before every procedure to ensure your safety.
Some medical centres rely primarily on endoscopists to deliver a sedation option known as mild or “light sedation.” You can think of light sedation as two steps down from deep sedation and some patients request it as they prefer to be more aware and awake during their procedure.
Because this type of sedation can be overseen by the endoscopist it may be the strongest type of sedation offered in clinics where an anesthesiologist is not available.
As you may have heard, our health-care system is experiencing a significant shortage of anesthesiologists, especially in Ontario, and this can impact the types of sedation available for your colonoscopy. In this province, any colonoscopy that requires more than light sedation involves an anesthesiologist or an FP-A. If deep sedation is something you want for your procedure, please inform your health-care team and request to be referred to an appropriate hospital or clinic.
Light sedation is always administered through an IV, however, a different combination of drugs is used than in deep sedation. If you are given light sedation, you will likely receive some forms of anti-anxiety medication and opioid painkillers. This combination should leave you feeling relaxed but awake; you’ll be able to carry on a conversation and follow instructions. You may have some recollection of your procedure and may note some discomfort. Light sedation is commonly used and is usually well tolerated. In Ontario, it’s also usually administered by a nurse under the direction of the endoscopist.
General anesthesia —which renders you completely unconscious for the duration of your procedure and requires breathing support— is rarely used for a colonoscopy; however, there may be situations where this is an appropriate choice and it’s sometimes a required backup plan. General anesthesia is always directly administered by an anesthesiologist or an FP-A.
Can I receive a colonoscopy in Ontario without any sedation?
Yes! While this isn’t a common choice, it is one you can make. It won’t exactly be comfortable—you can expect cramps and gas pains—but there will be no downtime following the procedure, meaning you can drive yourself home or to work and you don’t need anyone to keep an eye on you.
How To Prepare for Your Sedation
All colonoscopies have very specific instructions that must be followed to ensure a successful procedure. It is very important that you follow these details. Procedures can be canceled or postponed if the instructions aren’t followed.
While these instructions can vary slightly from clinic to clinic, they all include a period of fasting. This fasting is necessary not only for your scope but also for your sedation.
If you regularly take any prescription medicine, vitamins, or supplements, please confirm with your health-care team that you can continue taking these up to and including on the day of your procedure. Please also speak with your physician about any over-the-counter medication you plan on taking that day, including any OTC painkillers.
It’s also important that you let your health-care team know if you use alcohol, cannabis, or any recreational drugs. The intent behind these questions is never to judge you, but instead to provide you safe and adequate anesthetic care. Your team needs to know this information as it can impact which medications and what doses are needed to achieve that optimal sedation level and wake you up timely and comfortably. Most physicians would recommend no smoking, cannabis, or recreational drugs for 24 hours before the day of the procedure.
Depending on your procedure, you may be able to wear regular clothes. If that’s the case, it’s recommended that you wear something loose and comfortable. If you normally wear contact lenses, it’s recommended to wear glasses to your procedure, due to the risk of dislodgement.
Post-Sedation Care
After your colonoscopy is over, you will slowly return to normal consciousness, and when deemed appropriate, be moved to a recovery room or area. Once in this space, most people find themselves alert within a few minutes.
Depending on where your colonoscopy was administered and what the exam was for, you may be discharged fairly quickly, sometimes as little as 30 minutes following the end of your procedure. You may or may not speak with your endoscopist prior to discharge.
After you’ve woken up, you may notice that your body feels unusual, such as heavy or tingly, and that your reflexes and muscles are slow to move. This is normal and will resolve once all the anesthetic has worn off.
It’s also common to feel a bit drowsy following deep sedation and you may experience a headache and/or nausea. These conditions usually resolve quickly with some rest and water. In general, people find recovery from deep sedation a quicker and smoother process than recovering from general anesthesia.
Even if you receive light sedation, you may feel tired or not your sharpest self following the procedure. We recommend not to make any important decisions for 24 hours following your procedure and any form of sedation.
You may also feel somewhat bloated and/or have stomach cramps. This happens because gas is put into your intestinal tract during your colonoscopy so that your endoscopist can conduct a thorough examination of your colon. Over the next few hours, the gas will be absorbed into your digestive system or pushed out of it in the form of farts.
Unless you have not received any form of sedation, you will need to arrange for someone to take you home following your colonoscopy and stay with you for the rest of the day. You will not be able to drive or take public transit on your own.
Due to the risk of residual sedation, you should not drive, operate heavy machinery, or sign legal documents for at least 24 hours following your anesthetics. Please also avoid alcohol, cannabis, and other non-prescription drugs during this period as they may interact with the sedation you were given.
If your sedation is administered by an anesthesiologist or FP-A, we promise to do our best to provide an experience that is safe, calm, and comfortable. If you have any questions about what to expect, please do not hesitate to reach out to your health-care team.