Skip to main content

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.

Comments

Popular posts from this blog

Becoming a Part-Time Physician

Next month my schedule will change.  I will henceforth be off on Fridays with my work week truncated to Monday through Thursday.   I am excited to be enjoying a long weekend every weekend.  And while the schedule change is relatively minor, this event does feel like an important career moment for me.  It is the first step on a journey that will ultimately lead beyond my professional career.  It is this recognition that makes this modest schedule modification more significant than one would think it deserves.  As some readers know,   my current employed position has been a dream job for me.   Prior to this, I was in a small private practice, which I loved, but was much more challenging professionally and personally.   My partner and I ran the business.   Working nights, weekends and holidays were routine for decades.   On an on-call night, if I slept  through until morning, I felt as if I had won the lottery.   And w...

When Should Doctors Retire?

I am asked with some regularity whether I am aiming to retire in the near term.  Years ago, I never received such inquiries.  Why now?   Might it be because my coiffure and goatee – although finely-manicured – has long entered the gray area?  Could it be because many other even younger physicians have given up their stethoscopes for lives of leisure? (Hopefully, my inquiring patients are not suspecting me of professional performance lapses!) Interestingly, a nurse in my office recently approached me and asked me sotto voce that she heard I was retiring.    “Interesting,” I remarked.   Since I was unaware of this retirement news, I asked her when would be my last day at work.   I have no idea where this erroneous rumor originated from.   I requested that my nurse-friend contact her flawed intel source and set him or her straight.   Retirement might seem tempting to me as I have so many other interests.   Indeed, reading and ...

Will Smarter Lawyers End Frivolous Lawsuits?

How do you know if a lawyer is any good?  Of course, they've all passed the bar, but now their profession is lowering it.  While most of us strive for excellence, and raise our children to value this virtue, prominent legal educators are establishing a new quality intitiative for their profession.  Who says that lawyers can't reform themselves?  Perhaps, we physicians can follow their bold example and raise the credentials of our pre-medical students.  I’ll present the facts. You be the judge. I have written a dozen posts on tort reform on this blog, which always generate spirited and adversarial retorts from attorneys and their supporters. They accuse me and other tort reform advocates of carrying water for insurance companies. They repeatedly point out that I know nothing about the legal system and are unqualified to opine on its flaws. They deride me when I argue that effective tort reform would reduce the practice of defensive medicine, despite the re...