What to Expect from Anesthesia at Your First Colonoscopy

Lucky you! It's time for your first colonoscopy! Whether you are right on schedule as a 45 year old headed into your first screening colo (that's GI-speak for colonoscopy) or you're having some GI issues requiring a quick look, rest assured that you are in good company. 15 million colonoscopies happen every year in the United States. Although colonoscopy is an incredibly common procedure, anxiety regarding what could happen the day of your colonoscopy can feel daunting.

Since this is your first one, or even if you're reading this and it's your 5th one, I want to take you through the typical anesthesia experience for patients scheduled for colonoscopy and provide with a few do's and don'ts. My hope is that if I can help you understand the general process of how this works, you can be more worry-free!

Anesthesia for colonoscopy is most commonly performed by administering heavy sedation. Sometimes that heavy sedation is called general anesthesia (since it renders a person unconscious and insensible to pain) and sometimes it is called MAC anesthesia which stands for monitored anesthesia care. No matter the technical term, for all intents and purposes, this will be done using primarily propofol, an anesthesia-inducing medication, while you are being monitored very closely.

So, what's the process?

Prior to arriving for your colonoscopy, you should have been notified by the GI office of a prescription for medication used to empty your bowel. The goal of your colonoscopy is to be able to visualize the inside surfaces of your colon. This enables the doctor to identify any abnormalities or find colon polyps which, if not removed, can cause colon cancer. It is incredibly important to follow all of the instructions provided by your doctor prior to arriving for this test.

When you arrive, you will be taken to a small room where you can change into a gown for the procedure. A nurse will talk with you and ask you questions about your bowel prep and go over some of your health information. He or she will also start an IV..

Having an IV can be stressful for some patients. Remember though, the IV will help your care team keep you safe in case of an emergency. Pain associated with starting an IV is temporary. Having anesthesia medication through your IV helps your procedure to be completely pain free since you will snooze right through the whole test!

Enter, your hero, the anesthesia provider!

Next, you will meet an anesthesia provider who will ask more detailed and specific health questions for safety. It is very important that you answer questions honestly and fully. You should also meet the doctor performing your colonoscopy.

After this, your anesthesia provider will take you to a procedure room where the colonoscopy will happen. He or she will place monitors on you- a blood pressure cuff, EKG electrodes (stickers on your chest), and an oxygen saturation probe on your finger, and also, a nasal cannula for oxygen or an oxygen mask. Any person who receives any type of anesthesia medication is required to be given extra oxygen like this, so do not be alarmed. Also, none of these things will hurt.

You will be asked to roll over onto your left side, and be sure you are comfortable in this new position. Once the team is ready, the anesthesia provider will begin to administer the anesthesia medication which is usually propofol. Propofol is an amazing medication that provides amnesia and somnolence (sleepiness). It works incredibly quickly and reliably and is very safe. In fact, propofol is used to put people to sleep for most surgeries in the United States.

After you fall asleep, your procedure will begin. Your anesthesia provider will monitor your vital signs as well as your physical reactions throughout the procedure extremely closely to ensure that you are safe. Propofol wears off very quickly once it's given, so you will be given a continuous infusion until the procedure is over. Most colonoscopies last about 30 minutes and your anesthesia provider never leaves your side.

Once your colonoscopy is over, your anesthesia provider will take you to the recovery area and you will wake up a little more. You may be given something that you like to drink and then helped to get dressed. Congratulations! You have made it through your first colonoscopy! Now, go tell all of your friends and family how easy that actually was and to get their colons checked!

Important Tips for a Successful Colonoscopy!

NPO (Nothing By Mouth)

Your doctor's office will inform you about when to stop eating and drinking, as well as how and when to take the colon prep medication. Please pay attention to these instructions as they will have a huge impact on the effectiveness of your test.

Regardless, you should not have any liquids, gum, mints, tobacco dip, or chewing tobacco within 2 hours of your procedure time. Eating or drinking within certain windows of time near your planned anesthesia time is very dangerous. Patients who consume food or even clear liquids too close to the time for anesthesia risk having gastric contents come up from their stomach and enter their airway. This can cause aspiration pneumonia which impairs your body's ability to oxygenate. This can lead to an ICU stay.

Pregnancy

If you are pregnant or think you could be pregnant, be sure to tell your nurse or anesthesia provider before heading to the procedure room. While propofol isn't known to cause birth defects or harm, there is increased risk for aspiration if you are pregnant.

Diabetes

If you are diabetic, be sure to let your GI doctor know when scheduling your test. Often, diabetic patients are scheduled for earlier in the day. Do not take your diabetes medications on the morning of your procedure unless you are a type I diabetic monitoring your blood sugar levels meticulously or are on an insulin pump.

Diabetes medications lower your blood sugar (glucose level). If you are not eating or drinking and continue to take diabetes medications, your blood sugar level can drop quickly which can lead to a medical emergency.

Weight Loss Medications

Ozempic, Semaglutide, Wegovy, Zepbound and other weight loss medications can cause your stomach to stay full for longer. While this may be helpful in losing weight, that full stomach can be dangerous for a patient receiving anesthesia medication as this can increase your risk for aspiration.

Tell your doctor and your anesthesia provider that you are taking this medication prior to arriving for your procedure. Often a special diet must be followed or the medication withheld for a period of time prior to your procedure.

Blood Pressure Medication

Generally, you should take your blood pressure medication as directed. If you are scheduled to take medication the morning of your procedure, do not take it within 2 hours of your arrival time. This means that you should take this medication earlier than 2 hours before or wait until your procedure is over. If taking the medication early, swallow only the pill with the smallest amount of water possible- preferably one tablespoon of water.

Driving

Many people report feeling great after waking up from a good propofol nap. Despite this, you still aren't ready to get behind the wheel. Always have a driver bring you to your colonoscopy and take you home. In fact, this is likely a requirement of the facility where your test will be performed.

Although the general anesthesia effects of propofol wear off quickly, you will still need to refrain from driving for the rest of the day and night. After receiving anesthesia medication, you are considered by law enforcement to be under the influence for the rest of the day. Stay home. Rest. Eat. Drink. Do not make big decisions, email your boss, or buy anything online that can't be returned.

**Information provided is intended as general healthcare information for the public and should be used as a guide. This information should not be substituted for the specific personal advice recommended by your own healthcare team who are familiar with your specific health history.*