Safety and clinical effectiveness of propofol for endoscopic retrograde cholangiopancreatography

Published:March 22, 2016DOI:https://doi.org/10.1016/j.ejim.2016.03.003
      Endoscopic retrograde cholangiopancreatography (ERCP) is an uncomfortable procedure that requires adequate sedation or general anesthesia for successful completion. For instance, over 48,000 procedures are carried out per annum in the UK alone [
      • Toner A.
      • Garewal D.
      • Keeling P.
      Safe anaesthesia for ERCP.
      ,
      • Department of Health and Human Services
      Petition denial for request for removal of warning of labeling for Diprivan (propofol).
      ,
      • The Joint Royal Colleges of Anaesthetists (RCoA) and British Society of Gastroenterology (BSG) Working Party
      Guidance for the use of propofol sedation for adult patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and other complex upper GI endoscopic procedures.
      ,
      • Paspatis G.A.
      • Chainaki I.
      • Manolaraki M.M.
      • Vardas E.
      • Theodoropoulou A.
      • Tribonias G.
      • et al.
      Efficacy of bispectral index monitoring as an adjunct to propofol deep sedation for ERCP: a randomized controlled trial.
      ]. We performed a prospective review of our hospital's ERCP records, to identify 660 subjects who required propofol. At our institution, propofol sedation for ERCP procedures is administered by anesthesiologists. The control group consisted of 330 patients that were not treated using anesthesia because of fear of anesthesia or because they were urgent cases. In all cases, written consent was necessary, as an acceptance to perform endoscopic intervention in procedural sedation and analgesia under ambulatory conditions. Instructions were given in written form. During the endoscopic procedure, basic monitoring was routinely used: ECG, heart frequency, non-invasive blood pressure measurement, pulse oximetry, capnometry, respiratory rate and the computer-generated BIS ranging from 0 (coma) to 100 (fully awake) reflects the level of sedation regardless of the patient's demographics and the type of hypnotic drug used. After the performed procedure, patients filed out an individual list of satisfaction degree, by encircling numbers 1–10 (unsatisfied–satisfied).

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