Not the best news for the New Year, but something that we all need to be aware of and get a little outraged over, just the same.
I have already written before about how Propofol is your friend and mine. Now, some insurance companies have determined that its use is medically unnecessary for colonoscopies. This is a bad and ill-informed decision on a number of counts.
Propofol is a drug with a quick onset and quick metabolism. What this means for YOU is that it will start working practically immediately, and last for the duration of your procedure, without any long-lasting after-effects. It causes no nausea or vomiting. It wears off quite fast. In small, titrated doses, it causes no respiratory depression.
Of course, colonoscopies can be done without Propofol; in fact, before the inception of this drug, colonoscopies were performed with various combinations of narcotics (think fentanyl, demerol) and benzodiazepines (think valium, versed), or without any sedation at all. They still are performed this way in many doctor offices and centers. My advice to all of you is to never opt for no sedation at all. As for the narcotic/benzo option, well, yes they work, but not without hitches.
Colons are long, tricky organs, with many twists and turns. Not so easy to navigate a 5 foot snake-like instrument through. A still, flaccid patient makes this a much easier endeavor for the colonoscopist and patient alike, and can often determine a successful or unsuccessful procedure. A comfortable patient has a relaxed abdomen. Narcs and benzos must also be given in incremental doses, like Propofol. Unlike Propofol, they do not wear off quickly, and narcs can cause nausea and vomiting (frequently) and respiratory depression. When narcs and benzos are combined, they pack a one-two punch, working synergistically together and often unpredictably. They also do not as reliably provide patient comfort like Propofol does.
Please give me Propofol for my colonoscopy.
Propofol needs to be administered by someone both very knowledgeable about how it works and very skilled in handling situations that may arise due to Propofol administration. Situations like airway and/or hemodynamic compromise. When an anesthesia provider gives you your drugs for your colonoscopy, YOUR heart, blood pressure, oxygen saturation, and breathing are constantly monitored for the duration of the procedure. Your anesthetist has no other responsibilities than watching over you to ensure a safe and effective anesthetic for the colonoscopy.
The insurance companies do not want to pay the anesthesia fee for these procedures. They would rather have YOU receive your sedation for this procedure by either the colonoscopist or one of his/her designated nurses (RNs) working with him. The same people who will be quite busy looking for any irregularities in your colon, biopsying lesions, removing polyps, filling out paperwork, applying abdominal pressure to assist in navigation of the large colon and otherwise involved in the procedure. All this, and administer incremental sedation while watching for and treating any side effects as a result of the drugs being given.
I’ve been involved in giving sedation for colonoscopies going the narcs/benzos route, and the Propofol route. The latter route has 100% reliable endpoints – namely, a sleeping, relaxed, comfortable patient. The former route is unpredictable and frequently provides inadequate, sub-par sedation.
Colon cancer is the our nation’s third largest cancer killer, after lung and protrate cancers. Getting people to have their colonoscopies for screening, let alone for symptoms, is Job One in both the prevention and treatment of this disease. Patients wake up after their colonoscopies with Propofol in disbelief that the procedure was even performed. Do you have any idea what kind of great PR this is for the person who may feel a wee bit scared of having a colonoscopy done?
Please give me Propofol for my colonoscopy. And don’t take away my anesthesia provider, either.