## [Scott Alexander's Live Journal on Colonoscopies](https://web.archive.org/web/20131230142807/http://squid314.livejournal.com/260594.html) Apparently it's relatively common for a patient to be in agony during a colonoscopy, but thanks to the anesthetic, they remember nothing. Here's SA writing about shadowing a gastroenterologist performing colonoscopies as part of his (SA's) medical training: > But about a quarter of the time, the anaesthetic didn't work too well, and the patient was awake and in horrible, horrible pain. Outside of movies and TV, I've never seen someone in such pain before. And watching someone literally writhing in agony is a terrible, terrible experience. > [...] > What did the doctor say? He told me that they couldn't up the anaesthetic because an overdose could cause respiratory arrest, and that it wouldn't matter because the anaesthetic on any dose caused severe short term memory loss and whatever happened the patient would forget all about it. The second point, at least, was right on. One patient spent the entire procedure writhing in agony and screaming something incoherent to God. The doctor finished the procedure, took out the endoscope, and cut off the anaesthetic, and the patient turned his head, looked the doctor right in the eye, smiled, and said, laughing "Wow, that wasn't bad at all! Guess I slept right through it!" How worried should you be over an anecdote from SA's defunct LiveJournal? Well, if you don't believe it, here's a study, too ([Midazolam-pain, but one cannot remember it: a survey among Southern German endoscopists](https://pubmed.ncbi.nlm.nih.gov/17489056/)). This is on endoscopy, not colonoscopy, but seems very related: >  Benzodiazepines, especially midazolam, are the most frequently used agents for gastrointestinal endoscopy worldwide. Among other parameters the quality of sedation is determined by patients' satisfaction assessed after endoscopy. This approach is misleading as the potent amnestic effect of midazolam conceals pain actually suffered during the endoscopic procedure involving distraction of the endoscopists from their actual tasks by audible reactions and defense movements. >  [...] > Ninety-eight percent of the questioned physicians felt that patients have pain during endoscopy with midazolam+/-opioid, but do not remember later. Ninety-two percent reported that it happens that patients moan aloud because of pain and almost half of the endoscopists (48%) reported of screaming. The majority of the endoscopists (91%) reported fierce defense movements with midazolam or the need to hold the patient down on the examination couch because of fierce movements, respectively (75%). Seventy percent of the endoscopists wished to have the rooms for endoscopy preferably soundproof away from the waiting room and 93% wished for better sedative agents. I hope they solve this problem by the time I start needing routine colonoscopies. h/t https://twitter.com/AndyMasley/status/1662307611138756608