As an invasive procedure, most colonoscopy protocols involve the use of sedation, although in rare instances patients may choose to forgo the use of sedation if adverse medication reactions figure significantly in their personal history. Most commonly, practitioners use intravenous medications, generally either benzodiazepine or propofol. Another potential is the inhaled sedation of nitrous oxide. Hypnosis offers another option for some patients. Finally, some promising developments have apparent association with reducing the quantity of sedation or other medication required.
A common sedation used for colonoscopy is benzodiazepine, administered intravenously. The practitioner may give this sedative by itself, or may combine it with a narcotic. Midazolam and diazepam are the most commonly used narcotics for this purpose. Because the narcotics can have side effects, a patient should fully discuss these options with the physician.
Propofol, also called Diprivan, may be used as a sedative medication during a colonoscopy. An advantage of this choice is patients tend to recover more rapidly. This drug is more potent than others typically used during this procedure, and at least one major insurer has eliminated coverage of this drug for use in colonoscopies.
An alternative to the intravenously administered sedation of benzodiazepine and propofol is inhaled nitrous oxide. Also known as "laughing gas," it doesn't keep colonoscopy patients as fully pain-free as the intravenous sedations, but patients have recovered faster using this option. This option may present a safer alternative for individuals with sensitivities to the more commonly used intravenous sedatives or for those with a general history of sensitivities to multiple medications who can be anticipated to have drug reactions even in the absence of a known sensitivity to particular drugs.
Another promising development in terms of safer alternative colonoscopy protocols for those with medication sensitivities is the use of hypnosis as a sedation technique during a colonoscopy.
Two Related Considerations
While not directly sedation techniques themselves, three specific factors have significance because they may provide safer alternatives for people with medication contraindications in their individual and family histories. One is a combination protocol with a conscious sedation colonoscopy procedure. A recent study showed that listening to music during the procedure enabled patients to tolerate the colonoscopy with one less dose of sedation. Another promising protocol is patient-administered analgesic, which allowed patients having non-sedated (or conscious sedation) colonoscopies to self-administer pain medication. Finally, while it is uncommon for patients to desire it, some individuals undergo a colonoscopy with no medication at all. It's another option that may seriously increase the safety for individuals with a strong history of adverse medication reactions.