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Twilight Sedation or Propofol - Choose Your Poison!

There are two ways to sedate patients for colonoscopy.  There is conscious sedation is when the gastroenterologist administers a ‘twilight sedation’, or moderate sedation when sedation is administered by an anesthesia professional, usually with propofol, a drug now known to most of us as  a contributor to the death of pop superstar Michael Jackson.

Most Patients Prefer Propofol over the Twilight Zone

Leaving issues of cost aside, most individuals involved in the colonoscopy experience prefers the propofol option.  Here’s why.

The drug is extremely safe when administered by trained personnel, who in most cases are Certified Registered Nurse Anesthetists (CRNAs).

Unlike with twilight anesthesia, the procedure is entirely painless.  Patients can expect to experience the same level of discomfort as they do with a haircut.

Knowing that they face complete comfort during the procedure, patients are relieved of anxiety that often precedes the procedure for several days or longer.

With a CRNA on the team, we have a professional at the bedside whose sole responsibility is to monitor the patient’s breathing and to make necessary adjustments in real time.

The endoscopy nurse, a seasoned R.N. professional, can now devote all of his or her attention to assisting the gastroenterologist and monitoring the patient knowing that the patient’s respiratory status and sedation are fully under the CRNA’s authority.

Recovery after the procedure is quicker and cleaner than with twilight.  In fact, patients often feel so well afterward, that we have to emphasize that they are still under the influence and are not quite ready to drive a car, fly a plane or command a nuclear submarine until the next morning. 

Using CRNA’s add to the cost of the procedure because these professionals are entitled to be paid for the work that they do.  Is it extra cost worth all of the benefits I have outlined?  As a patient, would you be willing to pay for the CRNA’s services out of pocket if your insurance company, who cares only for your health and welfare, only covered conscious ‘twilight’ sedation’?  Which option would insurance company executives or Medicare administrators prefer for themselves?   Perhaps, they would be more enlightened and empathic if they had to undergo sedation in the ‘Twilight Zone’ before issuing an edict declaring how much your safety and comfort are worth.


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