Sedation Options

Types of Sedation and Local Anesthetic

There are several options available to you to make your Endoscopy procedure easier. Different options, including no sedation or Entonox, are available depending on the type of procedure you are having, please refer to your procedure booklet sent to you to see which are available for your procedure. It is important to consider which option you would like to choose before you come for your procedure, as some options require you to have a responsible adult to collect you and fasting, which would need to be arranged in advance.

Lidocaine Throat Spray 

Lidocaine throat spray is a numbing spray used for procedures when the endoscope is passed through the mouth. It reduces sensation at the back of the throat and reduces the gag reflex, making the procedure easier to tolerate. It is a drug called lidocaine, the same as a dentist uses to numb your mouth during a dental appointment, except it is sprayed at the back of the mouth, instead of injected. It can taste unpleasant but is very effective in making endoscopy procedures easier to tolerate. It can make you feel like you can’t swallow, or like your throat is wooly.

If you chose to have this option alone for a procedure, you will need to stay in recovery for 15 minutes post procedure (as long as you are otherwise well), and you will be able to eat and drink after the spray has worn off, usually 10 minutes after the spray has been given. The nursing team will give you a glass of water in recovery to ensure you can swallow normally and have full sensation, and then you can eat and drink as normal.

Entonox 

Entonox is available for lower endoscopy procedures such as Colonoscopy and Flexible Sigmoidoscopy. It is an inhaled gas, sometimes referred to as laughing gas, and is a mixture of nitrous oxide and oxygen that is inhaled throughout your procedure using a mouthpiece. It is fast acting, and makes you feel more relaxed and less aware of any pain you might be experiencing. It is quick to work and quick to wear off, and can be controlled by you, as you will be holding the mouthpiece throughout the procedure, and you can decide how much you want to use it. As it wears off quickly, you only need to stay in the endoscopy department for thirty minutes after your procedure, and after that there are no restrictions in what you can do after you have been discharged. ​

Risks of Entonox:

Entonox is very safe, but can make people feel sick or dizzy, but as it is quick to wear off, the side effects also wear off quickly.

You may not be able to have Entonox if you:

Have had a recent head injury

Have had a recent injury or surgery to your face or eyes

Have a suspected bowel obstruction

Have any middle ear problems

Have megoblastic anemia

Have recently been deep sea diving or have a decompression illness​

Conscious sedation 

Conscious sedation is a medication given intravenously via a cannula (a plastic tube placed into your vein using a small needle) to make you feel sleepy and relaxed during your procedure and make it easier to tolerate. It will not put you completely to sleep, and you will not be unconscious. It can sometimes cause forgetfulness, so you may not remember the procedure afterwards. For certain procedures that last longer or are known to be more uncomfortable, your endoscopist will use a pain killer as part of the sedation, to help make the procedure easier.

Not everyone is suitable for conscious sedation, for example if you have breathing problems, but the nurse will discuss this with you when you come to the department.

If you choose to have conscious sedation you will be monitored in recovery after your procedure for a minimum of half an hour. Everyone is different, and sometimes the sedation can take longer to wear off, so you may be in recovery for longer than this.

Depending on the endoscopy procedure you are having, you may have already have been given fasting instructions in your procedure booklet, if so, please follow these.

If you have not, and you do want sedation, please do not have anything to eat 6 hours before your appointment time. You can drink up to 2 hours before your appointment time, but do not drink anything containing milk or cream. In the 2 hours before your procedure you can have small sips of water. Once you arrive in the endoscopy department you should not have any more sips of water.

The effects of the sedation can take up to an hour to wear off, but the medication stays in your system for up to 24 hours.

A responsible adult should collect you once you have been discharged and take you home in a car or taxi. They should stay with you for at least 24 hours. Be near a telephone in case of an emergency.

In the 24 hours following your procedure you should not:

·        Drink alcohol

·        Drive or operate any machinery

·        Sign any legal documents

·        Any other potentially dangerous activities (including cooking)

 Risks of Conscious Sedation

Conscious sedation can sometimes affect your breathing and your oxygen levels, although this is very rare. During your procedure your oxygen levels and heart rate will be monitored continuously via a peg that is placed on one of your fingers. You will also be given additional oxygen to breathe in through your nose. If there are any problems with your breathing or oxygen levels, the endoscopist can administer additional oxygen, or administer another drug to reverse the effects of the sedation.

If you are unsure 

If you are not sure about which sedation option is right for you, and you are considering conscious sedation, we advise that you prepare for your procedure as if you are going to have the sedation. This way, you can discuss your options with one of our endoscopy nurses when you come for your procedure, and you will still be able to have conscious sedation if you would like it. We will not be able to administer conscious sedation to you if you have not starved correctly and do not have a responsible adult to collect your after your procedure.

General Anesthetic 

We only provide general anesthetic for a small amount of endoscopy procedures. The endoscopy admin team will let you know if this is required for your procedure when they call you to book your appointment. If you are having a general anesthetic, you will be asked to come to a different department than endoscopy and sent specific information on how to prepare for your procedure. This information will be either sent to you by post or given to you over the phone by the endoscopy admin team.