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Entonox

Entonox is sometimes referred to as ‘laughing gas’ or ‘gas and air’.

Entonox works very quickly and its effects are felt almost immediately after inhalation, providing very good pain relief with a relaxing effect without losing consciousness or control.

Entonox can be used as an alternative to intravenous sedation and pain relief for endoscopic procedures examining the bowel such as colonoscopy and flexible sigmoidoscopy.

Entonox is self-administered via a mouthpiece; therefore, you are in full control of your own pain relief requirements and will remain entirely awake during the procedure so many people find this is a more convenient approach.  After stopping inhalation, the gas and its effects wears off quickly. Due to this there are no restrictions for driving after discharge from the unit and you will not need anyone to look after you at home.

When the endoscopist is ready to start your procedure, the nurse will instruct you to take six to eight breaths of Entonox before your procedure starts. This will give the Entonox time to take full effect and for you to feel comfortable using the gas. You will then breathe the Entonox throughout your procedure whenever you feel uncomfortable.

There are no serious risks and very few side effects from inhaling Entonox gas. Occasionally you may feel some light headedness, some tingling in the fingers and face and a little sickness or dizziness. This usually happens if you are breathing the gas in and out too quickly. If this does occur, the nurse will tell you to slow down your breathing and the side effects will stop.

Throat spray

Is a local anaesthetic spray that numbs the back of your throat to minimise discomfort in the throat during Gastroscopy and this helps the camera to be inserted into the food pipe (oesophagus).  Many patients state that this tastes like bananas.  A diagnostic gastroscopy usually takes less than 10 minutes and the throat spray wears off after approximately 30 minutes.  The throat spray will help to reduce a natural gag reflex that all patients will experience.  This sensation can be unsettling but staff will support you with breathing techniques.  Please note that this sensation will not completely go away with throat spray and/or midazolam. The length of time for the procedure if you have throat spray only, conscious sedation or both remains the same.  Following the procedure MOST patients are discharged from the room if they had ONLY throat spray (only available for Gastroscopy procedure), whilst those having conscious sedation will spend approximately 30-40 mins in recovery afterwards. 

The other benefit of having throat spray is that you do not require a friend or family member to accompany you and you can drive a car or operate machinery straight away after.  For this reason many patients choose throat spray for diagnostic gastroscopy.

Conscious sedation

With conscious sedation you receive an injection of one or a combination of drugs to relax and reduce discomfort. Commonly in Plymouth we use a drug called Midazolam (a sedative or relaxing drug). Sometimes this may be combined with a strong painkiller called Fentanyl.

IV Midazolam is administered via a cannula into your hand or arm.  A cannula is a small plastic tube inserted with a small needle into a vein.  A cannula can be a little uncomfortable and it can cause some bruising.  This usually heals after a few days.  The cannula is removed shortly after the procedure is completed.  If you think it is likely that you will opt for conscious sedation and have had a history of needing an Ultrasound for finding a vein in the past – please let the unit know in advance as this will need to be arranged prior to you attending for your procedure.

The endoscopist/nurse providing the sedation will discuss with you what is best on the day. These medications are designed to make you feel comfortable and relaxed but are not anaesthetics and it is not intended to put you to sleep.

Conscious sedation may provide a more comfortable procedure but has the disadvantage of requiring a more prolonged recovery in hospital (approximately 30-40 mins in recovery afterwards).  You will also need to arrange to be collected from the unit, be accompanied home and have someone to stay with you for 24 hours.  You should not use public transport to return home and you are not permitted to operate machinery, drive a car for 24 hours after sedation or sign any legally binding documents.

There are risks associated with an IV sedative, as this can reduce the body’s natural breathing response, however nursing and medical staff will be assessing you at all times.

You may require additional oxygen support via a soft sponge/tube into the nose.

This is when an anaesthetist puts the patient fully to sleep. This is a more specialist and prolonged process than sedation. In general, this is reserved for complex endoscopy procedures that are likely to take a long time and is only rarely appropriate for a short or diagnostic procedure.  There are limited lists for general anaesthesia therefore all referrals undergo a stringent triaging process by the Endoscopy Clinical Lead/Sister to ascertain that they meet the criteria.  This is not offered to patients as a preference.