28 Jan Sedation for Lower Endoscopy
Of the many myths surrounding health and healthcare, one conception that is worth dissecting before the patient is that of the use of sedation during lower endoscopic procedures.
During the past decade, the media passed through the notion that lower endoscopies were cruelly carried out in the public service without sedation, as result of economic restraints. What are, then, truly, the implications of the use of sedation during and endoscopic exam? Do costs escalate? Yes, naturally. Sedation requires the use of additional drugs and, most importantly, the presence of an anaesthetist and an anaesthesia nurse, i.e. two additional specialised healthcare professionals. After sedation, the patient has to be monitored, to ensure safe recovery and reversion of drug effects, requiring a longer stay after the procedure and a dedicated nurse to activate medical attention in case of need. There is no question sedation increases costs, greatly.
The important question, then, is whether or not sedation is in the patients´ best interest. Is it? Not necessarily.
To begin with, many patients tolerate “simple” lower endoscopy quite well. Secondly, sedation per se is not innocuous. Thirdly, with sedation the patient becomes unresponsive to pain, leaving the endoscopist only visual and tactile clues of warning against possible aggression. The consequence is a multiplication of the risk of adverse events during the exam, which may be small or huge, depending on experience. This increase in risks of a procedure which, in many cases, particularly when screening, leads to no findings or treatment is, to many, unacceptable.
So, why then, do we use sedation at all? Because, for many patients, carrying out the exam would otherwise be impossible. Sedation should be indicated then when, due to anxiety, pain, a difficult anatomy or a required intervention the exam on its own will predictably not achieve its aims and, therefore, the risks of sedation become outweighed by the superior interest of completing the procedure.
The generalised application of sedation, then, lacks interest to most individual patients. It is, quite simply, an adjunct, that may and should be used to allow otherwise unfeasible procedures.
If you come to require a lower endoscopic exam, specially in the context of screening, in the absence of symptoms, relax and make an attempt to comply.