Anesthesia and deep sedation increase colonoscopy risk
Propofol or deep sedation for colonoscopies increases costs and risk
This week, the family of an elderly lady who had gone to the hospital for a routine, elective colonoscopy, called to ask Painter Law Firm to investigate a potential wrongful death matter.
The family was shocked to hear that the patient had a heart attack during the colonoscopy and passed away. Upon reviewing the medical records, they discovered that the healthcare team proceeded with the colonoscopy without getting cardiac clearance first.
As a Houston, Texas medical malpractice lawyer, I have seen more and more gastroenterologists and physicians use deep sedation for colonoscopy. Many gastroenterologists routinely order a cardiac clearance test—usually in the form of an EKG—before a colonoscopy done without deep sedation, based on the added stresses that the anesthetic drug plays on the heart.
Prior to the development of fast-acting anesthetic drugs, like Propofol (diprivan), many physicians did not use deep sedation when performing colonoscopies. In fact, a Dallas-area anesthesiologist who I have hired on a number of cases as a medical expert witness told me that she chooses no anesthesia at all when she undergoes a colonoscopy, because she is uncomfortable with the level of risk.
Many patients are probably not that bold, but other options are available. It is important to know these options, though, because going under deep sedation or general anesthesia is not a risk-free proposition.
In 2013, the New England Journal of Medicine reported that anesthesiologist-administered propofol sedation is increasing in the United States and leads to a shorter recovery time and an estimated 20% increase in the cost of a colonoscopy.
A shorter recovery time means that a gastroenterologist can perform more procedures and make more money. Unfortunately, though, propofol use during colonoscopies also increase the risk of aspiration, perforation, or splenic injury. In addition, in my experience, any time deep sedation or general anesthesia is used, there is an increased risk of cardiac or respiratory arrest.
For all of these reasons, many experts recommend using the least-sedating medication available. A common choice is Versed (midazolam), which is a light sedative.
What you can do
For most people who have no symptoms, a joint guideline put out by the American Cancer Society, US Multi-Society Task Force on Colorectal Cancer, and the American Ecology of Radiology recommends starting colorectal cancer screening at age 50. For some people with a significant family history or other symptoms, screening can start even earlier.
Part of the recommending screening regimen includes colonoscopy. Current recommendations call for a colonoscopy every 10 years.
When it comes time for you or a loved one to have a colonoscopy, talk with your doctor about the type of anesthesia that you would like to receive. In my experience, many doctors brush over the fact that any alternatives are available to deep sedation. If you want to consider lighter sedation, like Versed, talk to your doctor about it. That is certainly my plan.
We are here to help
For free consultation about your potential medical malpractice case, call Painter Law Firm, in Houston, Texas, at 281-580-8800.
Robert Painter is a medical malpractice and wrongful death attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence lawsuits against hospitals, doctors, surgeons, anesthesia providers, and other healthcare providers. In 2012, he was honored with the prestigious AV designation by Martindale Hubbell, and, in 2017, was named one of Houston’s top lawyers by H Texas magazine.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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Published in the July/August 2018 edition of "The Houston Lawyer" magazine