I`ve been researching alternatives to conscious sedation during colonoscopy due due adverse events/reactions to IV sedation and found that, particularly in Australia, use of sevoflurane (nitrous oxide) is the standard. And, studies seem to show that it is cleared from the body faster than Versed or other drugs used here. Why is it not used in the U.S.? It is a cost or professional issue? 

Sevoflurane and nitrous oxide are anesthetic gases used in the United States, Australia, and everywhere else in between. It is certainly acceptable practice to administer sevoflurane and/or nitrous oxide for a colonoscopy. I am not sure which specific adverse events or reactions from IV sedation you are referring to but I am not aware of any scientific evidence that it has a better side effect profile than intravenous drugs like propofol and midazolam. Although sevoflurane is the least pungent of the inhalational (gas) anesthetics, some people still find it unpleasant. Like other inhaled anesthetics it often causes excitation and involuntary movement when used to induce general anesthesia so an IV agent is often needed in addition to the gas. Another problem is the pollution of the surgical or endoscopy suite that results from the use of gases, so that special gas scavenging and ventilation systems are required. And finally, use of sevoflurane often requires the insertion of an airway device, something which can usually be avoided during moderate IV sedation. 

I was told that for my scheduled colonoscopy I would be given Diprivan (propofol). I am on 45 mg Nardil (MAOI) and 10 mg of Lisinopril daily. In addition, I use a CPAP machine (100% compliant) for sleep apnea. Should I be concerned about any adverse reactions with the sedation Drug? Since the Lisinopril works with the Nardil in tandem to lower my blood pressure, if I am given too much Diprivan, should I be concerned with respiratory malfunction due to my sleep apnea? Is there another drug that would be better? What should I request to be in the procedure room and should I ask for an MD anesthesiologist? 

Thanks for your question. You are raising at least two, bright red flags. 1. Sleep apnea is a serious issue in any patient undergoing anesthesia. Airway obstruction is more likely to occur during and after anesthesia. Difficult tracheal (windpipe) intubation is also more common. 2. Nardil is an MAOI - a monoamine oxidase inhibitor. MAOIs can interact with certain anesthesia-related medicines, including meperidine (Demerol) and ephedrine, to cause severe reactions. In fact, until a few years ago it was standard practice to discontinue MAOIs before anesthesia. Although this is no longer routinely advocated, caution is still advised. In view of these two important and well-recognized anesthesia risk factors, it would be wise to request an MD anesthesiologist to provide your sedation for colonoscopy and to supervise your recovery. The anesthesiologist should advise you how to manage your medications before the procedure so ideally you will make contact beforehand. Finally, please note that in some centers, the use of lisinopril on the day of anesthesia is discouraged because in combination with general anesthesia (e.g. propofol) it can cause low blood pressure. This is one more reason to contact your anesthesiologist before the colonoscopy. 

I`m really nervous about an upcoming tummy tuck that I`m having. I`m a recent smoker but have decided to quit and am now using the patch. Are the risks during surgery the same as if you were still smoking? Should I remove the patch before surgery? My surgery is in 3 days, I`ve only been wearing the patch for 2 days, is even stopping at this late of date going to help? Should I inform the the anesthesiologist of what I`m doing? Would it change the way they treat me? 

Withholding information from your anesthesiologist about medication you're taking is a very bad idea. I'm sure you don't need to be told why! The most benefit is if you stop smoking for 6 weeks or more but stopping smoking for only 5 days is still worth it. Some people who have recently stopped have a temporary increase in secretions in the lung, a potential drawback. But other effects are positive, including eliminating carbon monoxide, carried on the hemoglobin of smokers, from your blood. Not to mention the potential long term benefits of having quit - reduced heart and lung disease, cancer, etc. I assume you mean the nicotine patch. Having the patch in place is not likely to change your anesthetic in any way. The patch provides a slow release of nicotine to combat withdrawal symptoms and the subsequent urge to smoke. There are no important interactions I know of between the nicotine patch and anesthetic medications. 

What type of source is the morphine drug. Is it a plant, mineral, animal, or synthetic? 

Morphine is derived from a flowering plant - the opium poppy, scientific name Papaver somniferum. It was first isolated in 1803! 

Do you allow your patients to take diuretics the morning of surgery? Is there literature to support either taking or not taking the diuretic? How long prior to surgery where you want a patients PT/INR to be normal do you have them stop coumadin? 

This is a forum for questions submitted by patient, not clinicians. I suspect you are a clinician, so I would normally suggest that you to try to get your question answered in some other way. However, I believe a few general comments about this issue may have some value to the lay public so I will try to address it. Diuretics ("water pills") are commonly used to treat high blood pressure but are also given to patients with heart failure, or to treat swelling of the legs (edema). They are very useful medications, but they cause at least two problems when taken on the day of a surgical procedure. Firstly the need to urinate after taking a diuretic may be an inconvenience for patients travelling in by car. Secondly, and perhaps more importantly, diuretics may cause a decrease in blood volume ("hypovolemia") which can be detrimental during and after surgery and anesthesia, especially if the surgical procedure is a major one. So, under most circumstances, we tell our patients not to take their diuretics on the day of surgery. There are always exceptions to any guideline like this and patients should consult with their internist, surgeon, or (ideally) their anesthesiology about which medicines to take or withold on the day of surgery. The same advice applies to deciding when (or whether) to stop taking coumadin, a potent anticoagulant (blood thining) medication - check with your doctor(s). Our usual practice is to have patients stop taking their coumadin four or five days before the procedure, and checking the PT/INR (a measure of how thin the blood is) by drawing blood on admission to the hospital or surgery center.