General anesthesia versus conscious sedation

[Guest guest]

I have been reading the posts about the GA versus conscious

sedation. I believe is correct about the anesthesia

though. I have been a medical transcriptionist for 28 year years

and NEVER have I ever done an upper endoscopy procedure under GA.

There is what is called MAC or monitored anesthesia care. This is

what is talking about. It brings you to the brink of

having to be intubated. They use fentanyl and Propofol and believe

me, you don't know anything so to the patient it might as well be

general anesthesia!

I have had this every single time I have ever had an ERCP. I tend

to wake up with just Versed and that is not a pleasant thing. I

refuse to have any upper (or lower) endoscopic procedure w/o it. It

is a hassle because they have to get an anesthesiologist and when I

go to MUSC that is always a separate thing but one that is not a

problem there.

I did have a situation up here in North Carolina where I had an

upper endoscopy and requested the MAC anesthesia and the insurance

company gave me grief later. Eventually, the doctor straightened it

out. Doesn't matter if I have to pay for it, I am not having any

endoscopic procedure iwthout it. I DO NOT want to wake up or know

what is going on. I had an " attempted " upper endo back in the 80s

before the advent of Versed. Now there is an experience you don't

want. I say attempted because I fought so hard, they stopped the

procedure. I remember every bit of it. After I got pancreatitis,

the one and only endoscopic ultrasound I had was done under

conscious sedation and lets say I was more conscious than sedated!

I woke up in the middle of it. At that point I told them the ERCP

wouldn't be done unless they put me out. They had no problem with

that but they sometimes don't offer unless you ask.

Thats my contribution to this subject all. Hope every one is having

a good day.

Kaye......NC

[Guest guest]

Keeping in mind the caution that made concerning the

imprecision with word or phrase choices that doctors make (that

is, concerning the venacular that they choose to convey

information to patients) I want to suggest that those of us who

believe that true GA was used, as opposed to the near GA I may

be correct. It seems that while it is not common to use GA it does

happen and maybe even more so in the coming years; I found

the following abstract when I googled " ERCP " then " General

Anesthesia " . A bunch of hits came up and I only scanned a

couple of them. This article did not define what is meant by GA

but a different one that I accessed made it clear that GA was the

full intubation route. I am assuming that in an article of this

nature (peer reviewed journal) that the definition of GA is the

intubation kind too. I can probably get access to the whole

article if anyone cares to read it.

(why do you think it was indicated for substance abuse?

Because of tolerance to narcotics? Do you think that is why

some of us are GA'd and not others based on our medication

history? Could that explain the the differences? and why some

that are consciously sedated, have such bad times of it? )

" Endoscopic retrograde cholangiopancreatography under

general anesthesia: indications and results.

Etzkorn KP , Diab F , Brown RD , Dodda G , Edelstein B , Bedford

R , Venu RP

Gastrointest Endosc 1998 May;47(5):363-7

Conscious sedation is usually used during endoscopic

retrograde cholangiopancreatography (ERCP). Little is known

about the indications and outcomes for ERCP in patients who

cannot undergo conscious sedation and therefore require

general anesthesia. We retrospectively evaluated the indications

and outcome for patients undergoing ERCP who required

general anesthesia at four teaching hospitals over a 2-year

period. METHODS: Of 1200 ERCPs performed over a 2-year

period, 65 patients required general anesthesia. Retrospective

chart analysis was undertaken to determine indications and

outcomes of ERCP performed under general anesthesia. Eleven

patients underwent sphincter of Oddi manometry. RESULTS:

The major indication for general anesthesia was substance

abuse. Therapeutic intervention was successful in 45 of 48

patients; 6 of the 63 patients had complications, all mild and not

related to the anesthesia. Sphincter of Oddi manometry was

normal in 7 patients; 4 patients had elevated basal pressures.

CONCLUSIONS: ERCP under general anesthesia may be

considered when conscious sedation fails to achieve a

satisfactory level of sedation for a successful and safe ERCP.

Procedure-related complication rates appear to be comparable if

not lower with general anesthesia. "

[Guest guest]

Karyn

Its interesting re th epic cline didnt know they coudl sedate you an I

will definitley ask for it next time.

I had 2 anesthtists stand there for yges 1 1.2 hours tryign to push it

inserted into my arms. I was screaming in pain with my mum cringin

beside me.

I wont do that again

I now have to have ivs done in my feet arghhhhh ad the latest round

with the nurse who are always better then docs in the ER is to stick

both arms and hands in jugs of hot water thats what they do for cancer

patients hey they didnt get it first time but the second nurse got one

in mynad they thougth it cruel to use my feet for a ppca

debs