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I'm having endoscopy/colonoscopy this week need advice
I am having an endoscopy and colonoscopy on Fri. and I asked my dr about sleeping under sedation without my cpap machine. He said it will be fine because I won't be asleep that long. Anybody familiar with this?
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Replies to This Discussion
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Permalink Reply by Neal Buckner, LRCP on
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Propofol (AKA Milk of amnesia) is being used more and more becausee of it's short acting properties and fast metabolization. During the procedure you are monitored. Either a respiratory therapist or an Anestesiologist is right there at the head of the bed. Wearing a CPAP during this procedure can get in the way especially during an endoscopy. Use common sense. Tell your doctor about your condition. If you are doing this as an in-patient, of course bring your CPAP/Bi-level so it will be there for you when you go back to your room to sleep. If this is an out-patient procedure then use your PAP therapy as you would at any other time. When ever you sleep! Over the last 20 years as a RT I have assisted with hundreds of endoscopies and colonoscopies. If at anytime you become obstructed a simple chin lift/jaw thrust will resolve the issue until the sedation wears off. And not only is your heart rate monitored but you O2 sats and exhaled CO2. This is a routine procedure. But as with any procedure there can be complications. Relax. The professionals do know what they are doing and more than likely have seen dozens of folks just like you with OSA. Never a bad idea to have your PAP with you just in case you change from an out patient to an in-patient.
Good luck! Hope all comes out normal!
susan mccord said:Makes a great case for ALWAYS having a family member or close friend WITH you during and after any procedure until you're fully awake..........
Susan McCord
susan mccord said:After everything I've heard recently about Diprovan, I'm not ever gonna want THAT drug for ANYTHING. It's scary, in and of itself...
I'm due for a colonoscopy too and have been wondering how it would be handled. My hospital has a huge professional building that's attached, but it's a separate building with direct access into the hospital. The colonoscopies are done in the clinic in that professional building. It's not a real fast trip to ER from there, but that's where they took me when I had chest pain during my first sleep study. I just don't know enough about sedation and CPAP to know how to think about it.....looking for input here from anyone else who knows about it.
I took someone for a colonoscopy, and he woke up completely right afterwards and wasn't sleepy the rest of the day. I've heard other people say the same thing. Judy makes a good point, though, about any procedure that leaves you sleepy afterwards. Jeez, even dental surgery knocks people for a loop. The more I get into these kind of concerns re: CPAP and other kinds of healthcare, the antsier I get.....not about CPAP, but about during and after procedures.....
Thoughts?..........
Susan McCord :-)
Judy said:'Scuse me, but someone standing by your side whilst you are under sedation and there when you wake isn't a heck of a whole lot of consolation. There is a REASON they tell you not to drive or make any important decisions for 24 hours!!! It actually is NOT DURING the procedure that we are at greatest risk, we are closely monitored during the procedure, it is AFTER the procedure when they just check on us and we aren't closely monitored that we need our CPAPs. AND we need them when we get home and are still sleepy and groggy if we feel at all inclined to lay down, even if just "for a minute".
Propofol (diprivan) is being used more frequently for endoscopies, colonoscopies and other short outpatient procedures at hospitals. Most states require its adminstration ONLY by an anesthesiologist because altho a very SHORT ACTING drug THERE IS NO ANTIDOTE. Free standing clinics and doctors offices are unlikely to have an anesthesiologist and full life saving ER equipment on hand. At best most would only have resuscitation equipment to hopefully sustain you until you could be transported to an ER center.
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Permalink Reply by Sleepytime on
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I woke up during a colonoscopy and a small surgery - and I think it was because I was having apneas, I've heard if you take your Cpap equipment with you on the day of the proceedure it can be used - and I sure will next time I have anything done!
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Permalink Reply by Steven Y. Park, MD on
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Most major hospitals and ambulatory surgery centers have set protocols on screening for sleep apnea and procedures for treating people with known sleep apnea. If you have to stay overnight, by all means, bring your CPAP. As for having it next to you while you undergo the procedure, by the time you're in trouble, believe me, CPAP is the last thing they're going to consider. You're be resuscitated via normal airway obstruction protocols.
In my experience, communicating with the anesthesiologist about underlying sleep apnea is crucial. It's controversial whether conscious sedation is riskier than general anesthesia (with intubation, you're airway is protected). But with either, there are small risks. With intubation, after the tube is removed, that's when things can go wrong. Usually I tell my anesthetist to extubate when the patient is fully awake. Many anesthesiologists remove the tube when the patient is still deeply asleep, but this can be done safely if proper measures are taken (nasal airway, oral airway, both, good suctioning, making sure the IV is SECURE, etc.)
If you're undergoing conscious sedation (twilight anesthesia), then with too much sedation, the tongue can collapse, but typically they'll be able to ventilate you with a jaw thrust and manual ventillation. An oral airway can be placed as well if you're not undergoing an upper endoscopy.
Ultimately, it's the competence and experience of the medical personnel involved. You can have protocols in place but if not followed properly, then you're in trouble. You don't have to have institutional protocols, but with good anesthesiologists, you're OK.
I'm somewhat biased in my opinion, since I'm an upper airway specialist (all otolaryngologists/ENTs are by definition). Anesthesiologists call ENTs when they can't control the airway. I also work in a hospital where we only do eye and ENT procedures.
There's a lot more awareness on the part of medical professionals these days, and as long as you mention it to your doctors, you'll just have to trust their judgement. Even in the best of hands and with everything in place, things can still go wrong. Fortunately, these episodes are rare.
Susan, Good luck, and please keep us up to date.
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Many top places have a policy that instead of sedation, with sleep apnea you have general anesthesia (with an anesthesiologist in attendance, who can reverse the anesthesia if you run into breathing issues). Often insurance has to pre-approve the anesthesiologist. At least, this is true in Chicago, where I last had an endoscopy/colonoscopy done at Rush University Medical Center. Oxygen should be given, and continued until you are no longer drowsy (fully awake).
This is what Rush does and says. I can't vouch for other places. I have Central sleep apnea and Obstructive, i.e. complex or mixed apneas, and for the Central sleep apnea, sedatives are not advisable, so this is the protocol they followed. For obstructive, if you will be on your side (left side), you are less likely to have apneas than on your back. Usually at least the colonoscopy is done on your side.
Time-wise, you are probably looking at 50 minutes or so for both procedures.
Vicki in Illniois
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Permalink Reply by Raymond J. Young, Jr. on
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Although this is a sleep apnea forum, if you are having any procedure which requires sedation and have RLS/PLMS you should also notify physicians. They might otherwise not know what to do with you!
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Permalink Reply by Bill Grace on
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I RECENTLY HAD THESE TEST AND MY DR. DID NOT REQUIRE MY MACHINE FOR THIS SURGERY. HE SAID THERE WERE NO PROBLEMS. YOU ARE NOT DEEP DEEP ASLEEP DR. SAID THEY EVEN TALK TO YOU DURING THE TEST. THEY CAN TELL YOU TO TURN OVER AND YOU HEAR THEM AND DO THE COMMAND. I WOULD NOT BE CONCERNED WITH THIS, IT ONLY LAST'S FOR 10-15 MINUTES. HOPE THIS HELPS.
sleepycarol said:I had an endoscopy last year. I told the doctor about my sleep apnea and since I was admitted to the hospital I already had the machine there. The doctor told me not to worry since he would have someone standing by my side the entire time, even when coming out of the anesthesia. When I woke there was someone standing by my side.
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Check what type of anesthesia your doctor is using. I just had my fifth colonoscoopy and they don't use general anesthesia, but some thing called "twilight" anesthesia. I haven't had any problems with this.
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I reiterate: you are constantly monitored during the procedure whilst under general anesthesia, conscious sedation or twilight sedation. It is AFTER the procedure whilst you are in recovery you are at greatest risk. You are NOT monitored that closely, regardless of what they tell you, UNLESS you display signs of respiratory distress. Propofol (diprivan) is very short acting and your "wake up" quickly. HOWEVER, if you were also given an analgesic such as demeral or fentenyl or alfentenyl, etc. they also have some "sedating" effects and slow your waking AND keep you drowsy for a good part of the remainder of the day. Its not that inconvenient to take your CPAP and mask and have a family member w/you to start your xPAP therapy whilst in recovery. Better safe than sorry.
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Permalink Reply by Leslie Scott on
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Ok, I'm a little late on this one... but they usually put oxygen on you and that will bring your oxygen level up helping decrease the apneas. They have a pulse ox on you to monitor your oxygen level even after you get back to your room. They deal well with this stuff. Most of the time, our GI doc won't do a colonoscopy or endoscopy at her clinic with a known OSA patient, they make you go to the hospital. I was surprised when they did let my dh have his colonoscopy at the clinic.
When my dh had outpatient surgery at the hospital on Friday, they had him bring his cpap with. That way, when he started falling asleep after they got the oxygen off him, we put the cpap on. Every time he dozed off without the cpap, his oxygen dropped to 87% setting off the alarm and waking him up. They didn't want to put oxygen back on him because he didn't have oxygen at home. So I brought in the cpap and put it on him. He fell asleep and stayed above 90% and they let him go home. Granted, I took it in, set it up and gave him his mask to put on. Had to laugh when the nurse asked if we had it all ok. She then said she knew nothing about cpap and called respiratory. I laughed, said, well that works out well, "I am Respiratory" ;)
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Permalink Reply by RL on
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End of April, I had my first colonoscopy. It was done at a gastroenterology clinic that only does procedures for this medical area. Since I have OSA/CSA (complex), I informed them in advance. They told me I would be o.k. without the CPAP. They used Propofol (diprivan) as the anesthesia (short acting) and I requested oxygen due to the central apnea. They did give me the oxygen. The procedure went well and quickly. The recovery was in a mostly upright chair, which made the OSA less likely. I felt comfortable with their procedures and professionalism and was mostly awake at home afterwards until bedtime. I had a migraine two days before and the day after, but fortunately not during the prep and procedure, so the whole week was pretty much a down week for me. I don't believe they gave me any other pain or nausea meds, so I just used acetaminophen aside from the migraine triptan meds on other days. I'm glad for the overall positive experience as my results recommend for me to go again in three years.
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