Hi Spindles,
With you all the way on throat spray vs. sedation if you're over 65. I had my one and only gastroscopy at 69, albeit under slightly special circumstances. I'd swallowed my very spiky denture, and it had been stuck in my throat for three weeks, during which time I was thrown out of one hospital after another, and told I'd imagined the whole thing. (It didn't have any metal parts so wasn't radio-opaque.) At the end of three weeks, by which time I'd lost 7kg/15lb, was badly dehydrated and coughing up blood, a friend took me back to one of the hospitals that had thrown me out and insisted I was seen. A female doctor screamed at me that the denture was in my head not my throat, but luckily my friend held his ground - I was unable to speak at all by this time.
They grudgingly slotted me into that afternoon's gastroscopy list to "prove" I'd imagined it, while all the staff told me I was a time-waster, taking the slot from another patient who badly needed it.
I wasn't consulted re sedation, but was given a very small dose of throat spray (just two puffs) plus IV sedation. As a former nurse, I was well aware that they only ever give a half-dose of sedation to seniors, as there's a theoretical danger of cardiac or respiratory arrest in old age (cf. Jo@n Rivers).
I think the half-dose of sedation was the problem. It was enough to suppress my higher centres, which would have helped me to cooperate, but not enough to suppress the animal-like limbic system, which put me into fight-or-flight mode, struggling violently. It took six people to restrain me. I kind of knew what was going on and why, but just couldn't control myself. I'd have gouged the nurse's eyes out if she hadn't been kneeling on my arm. The procedure was a difficult one - even without my struggles - as the denture had become deeply embedded in the tissues at the entrance to the oesophagus, with severe infection and ulceration. Unlike patients who are given a full dose of sedation, I retained full recall of the whole procedure too. Worst 20 minutes of my life!
This is why I occasionally come on these boards advising seniors not to have sedation for endoscopy. Some seniors do find it's sufficient, and come out of the procedure with no memory of it, but they're much more likely to have a bad outcome with sedation than a younger person.
On the other hand, I wouldn't hesitate to recommend sedation for anyone under the age of 65 - or 60 in some areas. They'll come out of it with no memory whatever of the procedure, and all the stuff about being groggy for ages and not being alone for 24 hours afterwards is nonsense. (Though it is of course true that you mustn't drive yourself home after sedation.) The only exception to this is younger people who have a pre-existing heart or lung condition, as they might also be given a half-dose.
I never got an apology, though the hospital behaved impeccably afterwards, keeping me in for 24 hours on IV antibiotics. (Probably scared of litigation.)
The experience has put me off ever having a gastroscopy again, but if I did have to have another one at my age (73) I'd certainly opt for full throat spray while retaining my mental faculties.
Once again - none of this applies to any nervous under-60s who might be reading this. Don't hesitate to go for sedation if you'd rather not remember the experience. Equally, if you decide to go for throat spray alone, you'll be fine. It's the half-dose of sedation that is best avoided at all costs.