Conscious Sedation: A Personal Experience

Recently ASG received an email from a fellow CRNA who elected to experience her colonoscopy with conscious sedation rather than Propofol. The email states her personal experience and opinion on the benefits of Propofol anesthesia.

"I just want to share with you my experience as a patient. I opted to forgo propofol anesthesia for my endo for the convenience of scheduling. I weigh 139 pounds. They gave me Versed 10mg. Fentanyl 100mcg and phenergan (unknown amount). I am still feeling the effects of that very “unconscious” sedation 24 hours later. There is no way I could drive today. What we do in the GI centers is so important. I know many, including insurers, see it as an added expense, but there is absolutely no reason someone should lose this much time out of their life for an outpatient procedure. There is also no reason to give that much medication to someone and have them stay as long as I did to recover (well over an hour before I woke up and interacted with my husband). Feel free to share my experience with anyone who believes that so-called “conscious” sedation is either safe or effective. It is most certainly inefficient and potentially costly in the end.

I would NEVER forgo propofol in the future.

Not having an anesthesia provider readily available and knowing I received that much medication makes me feel extremely uneasy about what goes on without us in endo."

Have you or someone you know had an experience with "conscious sedation"?
What are your thoughts about your experience? Did you suffer from severe side effects from conscious sedation? Are you an anesthesia provider? If so, what would you recommend?

A Retrospective Study of A Gastroenterology Facility: Are the Patients Sicker?

With the ever increasing number of outpatient surgeries coupled with advancement in technology for non-invasive procedures and shorter acting anesthetics, more and more patients are being treated at freestanding surgery facilities. However, the trend in patient co-morbities has also risen, increasing the risk of providing anesthesia even though the procedures are so-called "low-risk". This makes one wonder are the patients being treated in freestanding surgery facilities really sicker than they appear? And therefore is their patient safety at risk?

In this excerpt from her dissertation titled A Retrospective Study of A Gastroenterology Facility:Are The Patients Sicker, Kim Riviello DNP, MBA/HCM, CRNA, President of ASG, will discuss the concerns for patient safety in freestanding surgery facilities, despite the procedures being considered "low-risk".

There has been substantial growth in the number of ambulatory surgery centers across the United States. With the advancement in technology for non-invasive procedures, and shorter acting anesthetics, more patients are being seen in the freestanding surgery facility (FSF). However, the trend in patient co-morbidities, i.e., obesity, diabetes, cardiac, and respiratory diseases has also risen, increasing the anesthetic risk even though low risk procedures are performed. The most common malpractice claims have been associated with diagnostic procedures performed in ambulatory surgery centers under monitored anesthesia care (MAC) with patient co-morbidities as contributing factors. The morbidity and mortality of ambulatory surgery patients has led to an increased concern for patient safety in freestanding facilities. Of particular concern is sedation, specifically in gastroenterology (GI) centers. Yet, the Journal of the American Medical Association (JAMA) recently reported that two-thirds of the anesthesia procedures provided during colonoscopies and endoscopies (EGDs) were on “low-risk patients;” suggesting the lack of need for professionally administered anesthesia in GI facilities and implying that specialist monitored anesthesia would contribute to the increased cost of these procedures (Liu, Waxman, Main, & Mattke, 2012). 

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