Recently there have been a lot of news reports regarding a study in the Journal of the American Medical Association’s (JAMA) which described deep sedation for colonoscopy as an “unnecessary expense”. I suppose I shouldn’t really be surprised, absolutely every expense is being scrutinized these days and the government’s health care related expenses seem to be especially under the microscope.
Deep sedation for colonoscopy, particularly the administration of propofol, has been proven to yield a higher polyp detection rate. It also makes the experience more pleasant for patients; and, propofol usage has no hangover-effect like many of the other monitored anesthesia care (MAC) options, which leave people feeling terrible for hours after the procedure.
More importantly, where there is propofol, there is a designated person (anesthesiologist or CRNA) present to monitor the depth of sedation. When lighter forms of sedation are used, the gastroenterologist must multitask by performing the colonoscopy and administering the sedation. Multi-tasking leads to missed polyps and lower rate of cecum intubation.
I think Mary Poppins nailed it when she said, “A spoon full of sugar helps the medicine go down.” People are sometimes reluctant to be screened due to embarrassment and concerns about the invasive nature of the procedure. Propofol makes the procedure truly painless. The efficacy of colonoscopy has been proven; the increased polyp detection rate while the patient is sedated is confirmed; and the gastroenterologist performs a higher quality screening when he/she is not multi-tasking. Let’s not focus on whether or not the anesthesiologist’s fee adds a small percentage to the bill. Let’s focus on how much higher the screening rate has become since the advent of this so-called “unnecessary expense”.