For my colonoscopies I requested just enough sedation to take the edge off. I was awake but comfortable enough. I believe they gave me Demerol. I didn't go into afib which was surprising since laying down all but guaranteed afib for me. I managed to stay in NSR for my ablation as well which shocked me since I was in afib the entire hour and a half drive to the procedure. They gave me Versed for the ablation but I remember everything that happened from before to after I woke up, Versed is supposed to have an amnesic effect but evidently not so much for me. Now that I'm post ablation I might opt for being knocked out for my next colonoscopy.

I understand your concerns, I had the same ones when procedures came along. Are you on an antiarrhythmic medication?

Hmm, I just added a post and it didn't go. I'll try again.

Thanks for your response, Steve! I am not on antiarrhythmics since about 3-4 mos after my ablation. HOwever, I had what felt like an a fib episode about a month ago and don't want anything that will trigger it. Of course NO anesthesia would cause a lot of stress and that is a trigger in itself!

You're going for full knock out next time, huh?

I'm not sure it is the anesthesia that is causing a fib during a colonscopy. It could be the prep messing up electrolyte balance (lower potassium, etc), positioning, or maybe the actual manipulation of the scope since alot of people seem to have GI triggers (like eating a large meal).

During colonoscopy they stimulate your vagal nerve that can cause all kinds of effects on the body. They also give antiemetics sometimes like Ondansteon ( zofran) which can cause QT prolongation and induce arrhythmia.
Conscious sedation anesthesia is not something that I ve seen to cause many problems for people with arrhythmias - I ve been sedating patients for years.
General anesthesia is usually the one to cause irritation to the atrium and induce a-fib.

P.S. - it is really not necessary to have anesthesia for a colonoscopy. It is commonly done in US because people don't want to remember anything and the doctors want the patients to stay put.
In my experience they give TONS of sedation during colonoscopies.. More than in other procedures I have done.
Ask them if they can give you some Versed ( Midazolam) and less Fentanyl. I ve also see them give Propofol for a colonoscopy which produces super deep sedation and it has no reversal agents while Fentanyl and Versed do.
I am really tempted to think that your Afib was caused purely by stimulation of the vagal nerve during procedure.
Of course, I am just guessing.

Heart- Good thing you have some time to look into this! Hopefully by then you will have a whole year afib free and won't even be worried!

Kelly

Yes, I heard that vagal stimulation is a big factor. Check this out though from the CVS Pharmacy website:

Factors that may increase the risk of atrial fibrillation include:
Age: 55 or older
Sex: male
Family history of atrial fibrillation
Cardiovascular diseases, such as high blood pressure, coronary artery disease, congestive heart failure, heart attack, heart valve disease, endocarditis, cardiomyopathy, congenital heart disease, prior episode of atrial fibrillation
Lung diseases, such as emphysema, asthma, blood clots in the lungs
Chronic conditions, such as overactive thyroid, diabetes
Receiving general anesthesia
Lifestyle factors, such as use of stimulant drugs (including caffeine), smoking, alcohol abuse, stress (either physical or emotional)


petey

Interesting. I had never heard of the vagal stimulation being the culprit. Now that I think of it, I did have propofol.

marikay, I never thought about the impact on the K levels. I wonder if we should take K supplements for the prep day??? Who knows what the level is though??

Thanks all!!

It is definitely how my AF started.

I wonder if there is study of what causes AF to start during medical procedures. As patients, we do not see the list of side effects that for any of the meds used for that procedure. There are studies for everything else.

Actually, from what I have read, there are 3 things they identify:

1) Anytime they operate on/mess with the heart, the heart reacts, possibly due to inflammation.
2) During colonscopies and gastric surgeries because of vagal stimulation.
3) With anesthesia, because it can increase vagal tone (and therefore arrythmias).
petey

We're pretty much darned if we do, darned if we don't!!

Aronia,

Thanks so much for posting that propofol produces super deep sedation. This is the first time I've read that. It may explain my experience with propofol. If you read this, would you let me know what you think?

Propofol was used when I had a colonoscopy about 3-4 years ago; I didn't have afib at the time. When I woke up I felt like I was waking from being dead, or what I believe being dead would be like with no afterlife. I didn't get upset about it, but I found it troubling. A couple of the medical personnel who were working with me before the procedure told me I would love the anesthesia. True, it kept me from experiencing any physical pain or discomfort during the procedure but I didn't like the feeling afterward.

When I had another colonoscopy about a year ago, after I had developed afib, I had a pre-procedure talk with the anesthesiologist. When I told him about my experience, he said it may have been due to a substance that was administered with the propofol, not the propofol itself. He said that substance could cause nightmares.

When I told him it didn't feel like a nightmare, that the trouble was it didn't feel like anything whatsoever, he said it sounded like a nightmare to him and dismissed it. He promised to avoid this second substance, but not the propofol. I also told him I tend to be sensitive to drugs; it usually doesn't take as much to work for me as it does for others. I'm not sure whether propofol was used, but I didn't have that waking-from-the-dead experience again.

Want to add that I didn't experience any afib episodes associated with the colonoscopy (before, during, or after), but my gastroenterologist really, really did not want to perform my colonoscopy because I had developed afib. He wanted me to have an ablation first! I was switching cardiologists at the time and both of them, as well as a cardiac electrophysiologist (EP), readily wrote letters to him approving the procedure. He still didn't want to do it.

I appreciate his caution, but am wondering if there's something unique about my case that accounts for his reluctance, almost refusal, to perform my colonoscopy. He wanted the procedure done in a hospital rather than a clinic and I was happy to agree to that - I liked having all that support available in case it was needed.

Anyone else had a gastroenterologist so opposed to performing a colonoscopy due to your afib?

He's retiring and I'm happy to move on to another gastroenterologist... and I think he's very, very happy for me to do so.

I also would prefer not to have a colonoscopy until my afib is under control, but I'm bringing my afib under control with supplements and lifestyle changes and do not want to have an ablation until I've given this my best shot. In the meantime I need to have colonoscopies.

I wish I knew more about his reluctance to perform my colonoscopy and my earlier experience with propofol. I'd also like to know how many people have had a similar experience with propofol or one of its companion drugs.

I read they use propofol and fentanyl together. Not frequently, fentanyl can cause hallucinations and nightmares.

From Stanford Hospital:

Surgery or medical procedures
Patients undergoing surgery or medical procedures seem to have an increased likelihood of developing atrial fibrillation. Almost any type of surgery seems to be associated with an increase in the likelihood of developing atrial fibrillation. Atrial fibrillation may even prior to surgery with the administration of sedatives or anesthetic agents, may occur during the surgery, or after the surgery. Heart surgery is associated with a significantly increased risk of developing atrial fibrillation, in many series up to 20-30%. Medical procedures such as endoscopy (looking down into the esophagus or stomach with a camera) or colonoscopy (looking into the intestine or colon with a camera) are also more commonly associated with atrial fibrillation. Even the colonic washout preparation for colonoscopy may precipitate atrial fibrillation. Surgery and medical procedures may alter the autonomic nervous system, stimulating to different degrees the sympathetic and parasympathetic nervous systems. Endoscopy and colonoscopy are associated with a particular degree of parasympathetic activation.

petey

Jan,

I think propofol is commonly given with fentanyl and versed. I dont' know why your GI doc was scared to do the colo.

Petey,
Your research was scary to read. I guess the key is, do you STOP having the a fib once you are done with the surgery or procedure? Or you continue having it afterwards?

I had afib for 8 days following my dental extraction...and epinepherine!