Sedation for gastroscopy

[Sandra126]

I have Barretts and had 3 gastroscopies in the past- the first was fine as the sedation knocked me out. The second was unpleasant and I noted that I had 5g of midazolam. For the last one I received 2.5g and I thought I was fighting for my life - choking, retching, panicking. Now it's time for my next endoscopy and the consultant says he will only give me 2g as this is now the maximum. Is this correct? Could I find another consultant? I'm inclined to say no - I'll take my chance with the Barretts!

[Magpuss]

My first two endoscopes were done without any sedation, I later discovered it was apparently that particular consultants 'preferred approach'. Once it became clear that this wasn't normal practice I made sure that I was sedated on subsequent occasions. Even with sedation it's not a pleasant sensation but without it I found it impossible to stop gagging and choking - however, if I'd decided to take my chances with the Barretts I very much doubt that I'd be here now. Metaphorically speaking, I think you just have to grit your teeth and remind yourself that it's a relatively short procedure and do your best to relax while it's being carried out. I count myself very lucky to have undergone the Ivor Lewis procedure, and three and a half years on I'm so grateful to my doc for sending me for those endoscopes. Don't take chances, take whatever sedation you're offered and give yourself a pat on the back for going through with it. Good luck & good wishes.

[Lara5]

Hi Sandra 126, sorry to hear of your bad experience, no wonder you are considering not having further gastroscopies. I have had several gastroscopies, without and with sedation. The last four have been post Oesophagectomy ( oesophageal cancer) for pyloric stretches. I never used to worry too much about them although unpleasant but after my big op I was very ill regarding food backing up and regurgitating everything so was admitted to hospital as an emergency. They gave me a general anaesthetic to see what the problem was and to remedy it. I woke up too soon towards the end of the procedure and the strong drugs were meant to have worn off but timings were slightly out I suffered few minutes of being paralized unable to move or get breath but totally conscious.. It was terrifying as they didn't realise immediately. When they did they acted quickly and were brilliant. I got many apologies from the team and high ups. Since then I feared the procedure so have had it with sedation. My surgeon has been fantastic and reassuring and I have received adequate dosage. Can you impress upon your consultant how anxious you are about it? And that it has made you rethink having another? Or have you already done that but no joy. I'm not sure exact protocol for different procedures but don't give up perhaps you could discuss with your GP. I still worry each time as terrible memory of general anaesthetic still with me. I wish you Good luck.

[ookymooky]

I was diagnosed with Barrett's four years ago and initially had several gastroscopies every year, in total I have had about 10 and I've never been sedated out of choice. In fact during the past fifteen years I've had a camera in every orifice and I've never been sedated for any of them. I suppose it's because I'm pretty matter of fact about most things and I don't want to feel like a victim and I like to know what is happening. Gastroscopy is a very simple procedure and if you go with the right mindset it's not unpleasant, it doesn't hurt, and it's over in minutes. You then sit for five minutes and then you can leave, get in your car and go. It really is a case of mind over matter and no you shouldn't "take a chance with Barrett's"

[AndrewB]

I have had so many gastroscopies and one doctor told me he didn't give high doses of sedation because it killed off brain cells. I asked where the patients choice was and he relented!

The point that has not been answered is is there any truth in that 2mg is the maximum they can give? Or is this just this consultant?

[chrisrob]

Having had Barrett's at least 21 years, I have had many endoscopies. However, sedation has no effect for me so I have them all without sedation and agree, they can be horrible. When I told one of the endoscopists this some years back, he approved doubling the dose of sedative for a scope but with no effect.

Following one particularly unpleasant scope a few years ago (on a Saturday with a locum when I was rushed through as if on a conveyor belt), I wondered whether it was worth it. I spoke to our specialist nurse who said they wouldn't use that same locum again and scheduled my next scope with one of our best consultants, whom I also consider a friend, and he was marvellous.

I did discuss sedation with him and he said they can add some opiate to the sedation if necessary - they usually do that when performing EMR or ablation therapies that may take a while and be particularly uncomfortable.

[Stan]

I am an endoscopy nurse and I work with many different consultants who have varying ideas on how a gastroscopy should be done. In our department we give up to 5mg of midazolam but I have to say that most people will manage a gastroscopy with throat spray only as sedation causes one to lose their inhibitions and fight more!

Some consultants will give throat spray and sedation.

I tell my patients to focus on their breathing and to take nice steady breaths and the test usually only takes about 3-4 minutes.

Good luck I'm sure you will be fine

[Hidden]

At one time I thought that sedation was the answer, and that was because I had personally had a good experience with endoscopy with sedation and knew others who had opted for that rather than the throat spray. But, as Chris says, there are some for whom it does not work well. I would have thought that the medical staff would be flexible because patients are sometimes so different.

The surveillance periods for Barrett's are beginning to change. I can understand taking your chances and going back at 5 year intervals if you have no reported dysplasia and otherwise feel OK. But if you do have dysplasia, especially a risk of high grade dysplasia you are playing with fire, so the answer is to try and persuade the consultant to be flexible and to work out a way of managing this process so that it does not cause you distress.

Having a proper endoscopy is a time consuming and delicate task for the person doing the endoscopy and I cannot believe that it is in anyone's interest to do this with a patient in distress.

[strangetimes]

That's interesting about the sedation resulting in loss of inhibition and resulting in people struggling .Can that really dazolam common ? Surely it would make the task much harder all round ? Personally I've found the throat spray not nice at all ,paralayses my throat and makes me feel as though I'm choking

Anyway - fwiw ,my first endosocopy was awful ,consultant calling for help to hold me down .But he was a pig - asked nurse for a pen to pass to me to sign consent forms and then THREW it back at her because it was a rollerball not a biro .Plus other charming mannerisms .

Point is ,since then I've been careful to impress on staff that I'm anxious and that I want assurance that I'll be sedated .

Another consultant told me that because I was small ( 5' ,size 14 ) they might have calculated a low dose the first time .

My last endoscopy I had 5mg of midazolam and 50mg of fentanyl - which is a painkiller but which also tranquilizes . I know that they have to be careful of the midazolam as it can supress breathing ,but maybe adding in the fentanyl would help you .

I've no idea about guidelines and lower doses ,suspect this is tosh as it must vary according to patient size ? But think ,if true ,it would be a local "rule" so might depend where you are .

Good luck ,press for good sedation .

Let us know how things go .

[Aurora12]

Hi Sandra,

like some of the others, I've had over a dozen Endoscopies in the last 3 yrs (I'm now down to 6 mthly. surveillance).

I HAD to have sedation for one of them, just after Radio/Chemo - but I opt for 'throat spray only' by choice - can then go by myself and am out straight after it! I've only gagged twice - 1) on diagnosis, when tumour blocked the scope and 2) when Endoscopist didn't warn me in time for me to TAKE A COUPLE OF SWALLOWS, JUST AS THE SCOPE IS FED DOWN THE ANGLE AT THE THROAT. (Any caring Endoscopists would get you to swallow!). I find that doing this really does stop me gagging. Once the scope's passed the throat, whilst you can feel it going down, you should have no pain or bother! I know it's easy for me to say it - but it does work.

Hope it might help you in your decision to be monitored/have any procedures! [Riskier to live with Barrett's and do nothing, in case it did progress - and was treatable when caught early]. Good Luck in the future.

[sophielewis]

Hi everyone from Australia

Well I have been reading your comments on sedation and think we must all be soft on this side of the world. Here you are always knocked out (twilight) and you have the throat spray as well. I am so grateful as the amount of endoscopies you have with oesophagus surgery. Although you are in hospital about 3 hours it is worth it and not distressing.

[Sandra126]

Thank you all so much for your replies, for the advice and for all your good wishes. I feel a bit of a wimp when I read of the troubles some of you have gone through.

The post from chrisrob ("on a Saturday with a locum when I was rushed through as if on a conveyor belt) described my last experience perfectly - never mind any calming technique, just shove the mouthpiece in and get the scope down as fast as possible!

I realise that I would be foolish not to get checked out, and so I have made an appointment with my GP to discuss the possibility of finding a more sympathetic consultant. I am now under a different NHS Trust since my first endoscopy was carried out, so I am considering going privately to the original consultant who had a caring, unhurried approach.

Thanks again to you all. I will let you know how I get on.

[AGood]

Hi all

I have Barrets too. I've had many gastroscopies over the years years. My last one put me off for life. I go into a full blown panic attack if I think I may ever have to have another. The consultant literally got the nude to push the plunger on the sedative as he put the plastic ring and camera into my mouth. Absolutely no time for the sedative to work. I gagged through the entire procedure and he took 5 biopsies. In the recovery room I was vomiting up blood and the consultant was called back as the nurses were concerned. He came in and asked what I was making all the fuss about.........'!!!!

I'm pretty sure that was my 10th gastroscope over the years and by personal choice, it will be my last unless I have a general anesthetic. It sadness me that some consultants have no human kindness whatsoever. Having said that, some of my previous ones have been brilliant.

Best wishes for good health to you all.

[Hidden]

I am beginning to wonder whether some of this might be influenced by workload pressures and the system not allocating sufficient time for proper Barrett's surveillance endoscopies / biopsies. That does not excuse the examples of when things have clearly not been done properly of course, but there does need to be a recognition that these procedures need time and skill if they are going to be worthwhile.

[david001]

Hi Sandra

Like others on here I have had loads of endoscopies and after having struggled on the first one with just a throat spray, always have 5mg midazolam. I didn't know they had reduced the standard dosage as I still have the 5mg which tends to be suitable for me.

I do believe that it is up to the anesthetist/consultant to determine the final dosage as they are performing a procedure, which needs to be undertaken without due stress to the patient.

I would have a word with the nurses next time you go in and explain your symptoms. I have never found that they have not been prepared to listen and your notes should advise them of the troubles you have experienced ion the past.

Good luck in your next visit but do continue to get your Barretts checked regularly

PS There is going to be a trend towards "Barretts only" endoscopists which might be helpful for those people who might be suffering and not yet diagnosed

[Stuart2012]

Never take a risk with Barrett's. It was during an endoscopy that I was diagnosed with cancer. Thanks to this it was caught at the earliest stage and completely removed with an oesphogectomy. I never had sedation, just throat spray out of choice. It was never pleasant and always made me gag, eyes water and feel uncomfortable. You just need to relax as much as possible, focus on breathing , close your eyes and imagine something more enjoyable!

[davidap]

like Stuart I owe my life to a sharp eyed NHS consultant (a Sikh) who was checking that a mild stomach ulcer had healed when whilst withdrawing the camera he spotted something "a bit lumpy" in my oesophagus. That led to several more endoscopies and eventually Ivor Lewis. That's six years ago now. Yes they are uncomfortable and I shudder to read some of the other peoples experiences but essential they sure are. I am surprised that with the speed at which most technology advances, that the camera has not shrunk in size, making it easier to insert.

[Sandra126]

Thank  you so much for all your advice and for sharing your experiences. Yes, I did have the gastroscopy eventually. I phoned the consultant who did the original (totally painless) procedure and he said the magic words "general anaesthetic". Unfortunately I knew another word would follow - "private"!

So I got out the credit card and went for it. Absolutely great; knew nothing about the gastroscopy and all was well. The biopsies were fine, so I've started saving up for the next one in two years' time.

It was worth every penny.

So thanks again everyone,

Sandra