• Welcome to Crohn's Forum, a support group for people with all forms of IBD. While this community is not a substitute for doctor's advice and we cannot treat or diagnose, we find being able to communicate with others who have IBD is invaluable as we navigate our struggles and celebrate our successes. We invite you to join us.

Versed shortage - sedationless colonoscopy?

I just got a letter today from my GI's office about the shortage of Versed, one of the sedatives used during a colonoscopy. From the letter, I gather they don't have any, and will instead offer either no sedation, or have an anesthesiologist there to give a deeper sedation that normal. Has anyone been through either of these alternatives? Honestly, I'd rather have deeper sedation than none.

Here's the drug shortage bulletin: http://www.ashp.org/DrugShortages/Current/bulletin.aspx?id=858
 

nogutsnoglory

Moderator
I haven't experienced that but considered your anxiety about the prep, I'm sure you aren't totally psyched about the procedure. It sounds like it would be best to just get a nap.
 
Well, my first five colonoscopies between 1999 and 2005 were all without sedation... that's not recommended. I would go for the deeper sedation.

I find it more than odd that they can't procure meds generally used to sedate patients for colonoscopies (those were you dose of and wake up 15min later and everything is done). Around here if a hospital or doc is in short supply of critical meds, it gets restocked within hours.
 
Hi :)

In the UK it is very rare for them to offer any sort of sedation, they usually just give you gas and air if you are in pain.

I am 21 years old, and thought i had a low tolerance for pain, but had my first colonoscopy a couple of months ago with no sedation, and although yes... at times it was very uncomfortable and I have to admit I did cry out in pain a few times, those moments pas quickly and after the procedure there is no pain. I had a strange reaction to the discomfort though and started to laugh uncontrollably and chatter my teeth in between saying "ouch"....
it feels like you have bad diarrhoea and you are getting those horrendus abdominal cramps you tend to get as you urgently scout for a toilet....
Plus you get to watch the whole procedure on wide screen :p and no long recovery period afterwards, you can just walk out after your 30 mins observation (if you have had biopsies) and drive home.

good luck x
 
I find it more than odd that they can't procure meds generally used to sedate patients for colonoscopies (those were you dose of and wake up 15min later and everything is done). Around here if a hospital or doc is in short supply of critical meds, it gets restocked within hours.
Usually that is the case, but the US Food & Drug Administration issues occasional bulletins about drugs that are in short supply for a variety of reasons- contamination at the manufacturing sites, equipment upgrades that take longer than normal at the manufacturing sites, a shortage of a key ingredient or a lack of a manufacturer. I couldn't tell why there is a shortage from the bulletin.

Several years ago, when I was injecting Methotrexate, there was a shortage because of contamination (I think in the bottles it ships in) and I had to call around to several pharmacies to find it.
 

SarahBear

Moderator
Location
Charleston,
Personally, I'd go with the deeper sedation, especially if you're going to be in any way nervous. Might as well, right? :p

I usually get completely knocked out for scopes. I find it to be easier that way - I sleep on and off again the rest of the day and by the time I wake up for good, I feel completely back to normal. All the prep effects have worn off and my stomach is feeling fine.
 

DustyKat

Super Moderator
:eek2: I would go for deeper sedation too!

I wonder though that they just don't use an alternative, like Propofol (with or without Fentanyl), to achieve the same result as Midazolam?

Dusty. xxx
 

rygon

Moderator
Ive had a twilight sedation (ie you are awake the whole time) and also gas and air, and although you do get small bouts of pain (like trapped air) I wouldnt say it was unbearable. The next time I get one i'll stick to gas and air as you can drive afterwards, and dont need to be looked after once the procedure is complete
 
:eek2: I would go for deeper sedation too!

I wonder though that they just don't use an alternative, like Propofol (with or without Fentanyl), to achieve the same result as Midazolam?

Dusty. xxx
Hi Dusty,

they wouldn't ever use Propofol as an alternative as propofol is not a sedative it is a very powerful anaesthetic- if it ere used the patient would have to be Tubed and hooked up to oxygen- they would needspecialists to come in and monitor her during the procedure and it would just be a waste of resources.
Though yeah, another sedative med could be useful if they are willing... some sort of benzo etc...
 
I've had both the Propofol and the Versed. I had a horrible experience with the Versed once, so don't ever want to do that again. Give me Propofol every time!

The difference in my experience is the need for anesthetist or anesthesiologist for Propofol versus monitored vital signs by nursing or assistants for Versed. The costs are a lot higher when anesthesia is involved, but worth it in my opinion for that expertise. That way the GI just gets to concentrate on the scope.
 
Ours is done with a combo using versed, propofol and something else I believe, they call it twilight bit you don't remember anything. You stay in observation 30 minutes or so after the procedure then whoever came with you can drive you home. I've heard the doc refer to it as light sedation and twilight, no anesthesiologist involved here with light sedation.
 

DustyKat

Super Moderator
I guess the difference in Oz is that the vast majority of scopes performed have an anaesthetist present. I personally have never seen one done without an anaesthetist accompanying the GI.

Dusty. :)
 
I imagine the propofal is what they are referring to with the anesthesiologist in the letter. I don't mind it, but I hope my insurance covers it, as I have no desire to pay out of pocket for it.
 
Yeah Dusty I think that is it. Also I might add when I had my gb taken out before surgery the anesthesiologists came and spoke with me about sedation with the colonoscopies he was present but there was no discussion, I just see him mulling about the scope hall and rooms, but it is the nurses that monitor I suppose.

Hmm..hubby has his colonoscopy consult Monday I'm going to ask about meds and anesthesiologists because this thread has me curious to our exact protocol here.
 

SarahBear

Moderator
Location
Charleston,
I imagine the propofal is what they are referring to with the anesthesiologist in the letter. I don't mind it, but I hope my insurance covers it, as I have no desire to pay out of pocket for it.
Could you call the insurance company and ask if they will before you have the procedure done?
 
Propofal is what I had the with my last. The colonoscopy center I go to switched from Versed two years ago. I liked the propofal better because it didn't make me sick when I was waking up but I was told I was out for a LONG time and then I went home and slept all day too. LOL I guess I needed a nap ;)

My own personal opinion is that I would NEVER EVER have a colonoscopy with out sedation. My props to those who can! I am in awww of you all!
 
Not an expert, but have performed LOTS of GI Procedures in my day assisting the Docs. I can only say that in My state, Propofol requires an anesthetist or anesthesiologist presence for administration. Versed and Fentanyl do not. I've administered a lot of it myself during the procedures. This light or "twilight" sedation is all done under the GI license and nursing license.

What I've found is that the medications change depending on the location of the procedure. If it's a surgery center or procedure center, they usually have anesthesia available. If it's a Docs office or a smaller facility without anesthesia available, you might get the sedation instead.

This is all premised on my own location in the states, and my own location and experience. I would hate to speak for other areas.
 
I called my insurance company. They will pay for the anesthesiologist/anesthetist as long as it isn't for complete anesthesia, with the tube in the throat and all. If it is the propolol that others have mentioned, then it will be covered. Trying to remember all the colonoscopies I've had over the years, I can't remember any ever using an anesthesiologist. The first few, in the late '80s and early '90s were done in hospitals, either when I was already inpatient or outpatient. After that, they started doing them in outpatient surgery center type places.
 
Not an expert, but have performed LOTS of GI Procedures in my day assisting the Docs. I can only say that in My state, Propofol requires an anesthetist or anesthesiologist presence for administration. Versed and Fentanyl do not.
I never thought of that! Totally makes since as a dentist can give Versed but not propofol. I had Versed years ago when I had my wisdom teeth extracted. Propofol has its down side like all other medications. Isn't that what did Michael Jackson in?
 
Hi Dusty,

they wouldn't ever use Propofol as an alternative as propofol is not a sedative it is a very powerful anaesthetic- if it ere used the patient would have to be Tubed and hooked up to oxygen- they would needspecialists to come in and monitor her during the procedure and it would just be a waste of resources.
Though yeah, another sedative med could be useful if they are willing... some sort of benzo etc...
Some locations have an anesthesiologist on staff, and certified anesthesia nurses handle the procedure with the MD available if needed. At least, they do that in Florida. The past three scopes I've had have all been under Protofol.

So it is done, though perhaps it is specific to a geography or location.
 
I have a tiny squeamish bone so I take absolute minimum I can get away with it helps you to recover quicker.also I,m just plain nosy I want to see and be aware of what's going on.its bizarre watching the picture of your insides,like a documentary on tv
 
I have had propofol and fentanyl given by an anaesthetist and found it much more effective and comfortable than versed.
 
Hubby went today for his pre-colonoscopy consult, his doctor practices at two hospitals, a smaller local one and larger one 45 minutes away. At the local one a nurse administers versed+fentanyl at the larger one you get propofol with anesthesiologist. Hubby chose local hospital so he will be getting the versed+fentanyl combo. LindaS, weird how there could be a shortage in Minn. and not in our area, hope all goes well for you!!
 
I just got a letter today from my GI's office about the shortage of Versed, one of the sedatives used during a colonoscopy. From the letter, I gather they don't have any, and will instead offer either no sedation, or have an anesthesiologist there to give a deeper sedation that normal. Has anyone been through either of these alternatives? Honestly, I'd rather have deeper sedation than none.

Here's the drug shortage bulletin: http://www.ashp.org/DrugShortages/Current/bulletin.aspx?id=858
I'm with you, deeper sedation or nothing. I can't take Versed; I had a severe reaction to it once during a colonoscopy which is what led to my phobia of them, eek. Anyway, my GI doesn't even like it, he has used Propofol in combo with fentanyl on me three times.

It also doesn't constipate Crohn's patients, which he said Versed has a tendency to do. It is a deeper sedation but oddly enough I wake up feeling much more alert and it's helpful too with the residual pain from the biopsies as well.
 
Top