Consumer Reports
Nov. 19, 2014
Getting knocked out during a
colonoscopy might seem like a good idea. After all, being awake as your
doctor uses a long, flexible tube to get an inside view of your lower
intestines doesn't sound very appealing. To avoid that problem, many
doctors now routinely use the drug propofol (Diprivan) during
colonoscopy to cause deep sedation in their patients.
But beware:
That drug, which was reportedly given to Joan Rivers soon before she
died, might not be the healthiest choice and could put you at risk for
some serious complications.
Don’t
get the wrong idea: Colonoscopies are usually safe (about 3 out of
every 1,000 people suffer a serious complication). And the procedure is
proved to prevent colon cancer deaths. So if you’re ages 50 to 75, you
should be screened (see our guide, "The Cancer Tests You Really Need," to find out how often you should be screened).
But
deep sedation isn't necessary. Colonoscopy can be done using conscious
sedation or even none at all. “You should always try to aim for the
lightest level of sedation that you need,” says Consumer Reports'
medical adviser, Orly Avitzur, M.D. “The trend toward deep sedation is
worrisome because it increases risk.”
For
example, propofol increases your risk of aspiration pneumonia (caused
by inhaling particles such as vomit, mucus, or saliva) by almost 50
percent, according to a study by Gregory Cooper, M.D., in the journal
JAMA Internal Medicine. And it can cause a host of other side effects,
including confusion, seizures, irregular heart beats, and potentially
deadly allergic reactions.
“For
the general population there’s not a lot of good data saying patients
have a better outcome with propofol when there’s not a medical
indication,” says Cooper, a professor of medicine at Case Western
Reserve University in Cleveland. “It’s overkill.”
Instead,
Cooper says he uses the narcotics fentanyl (Duragesic and others) or
meperidine (Demerol) combined with midazolam (Versed) to induce light
sedation during colonoscopies.
And
propofol is expensive. Colonoscopies using anesthesia cost about 20
percent more than those done without, according to Cooper. And a 2013
research letter in JAMA Internal Medicine titled, "Propofol for
screening colonoscopy: Are we paying too much?" said that the use of
propofol typically added $600 to $2,000 to the price tag.
Screening
colonoscopies are covered by insurance plans, thanks to the Affordable
Care Act, although you might have to pay for part of the
anesthesiologist’s fees, bowel prep kit, pathology costs, and a facility
fee. But even so, “Somebody’s got to pay for it, whether it’s the
insurance company or the patients,” Cooper says, adding that the current
system provides a financial motivation for using more anesthesia.
Read more about how to protect yourself from surprise out-of-network medical bills.
But
the rising tide of propofol use could be about to ebb. Beginning Jan.
1, 2015, Medicare is changing how it pays anesthesia professionals for
colonoscopy care. Gastroenterologists will be paid a set amount that
will cover the anesthesia cost, even if an anesthesiologist, for
example, administers it. Doctors will then have to decide whether to
recommend expensive anesthesia, which could include hiring a nurse
anesthetist or anesthesiologist and pay them out of the same pot, or
choose a less pricey option. “There may be a financial disincentive for
Medicare doctors to recommend deep sedation,” Avitzur says.
We’ll
have to wait to find out if commercial insurers follow Medicare’s lead.
If they do, says Cooper, “There will be less cost to the health care
system since there won’t be another bill from the anesthesiologist.”
Until
then, if you’re gearing up to have a colonoscopy, make sure you discuss
your anesthesia options with your doctor before the procedure.
