Results from individual studies suggested that patients have a better recovery profile after propofol sedation for ERCP procedures than after midazolam and meperidine sedation. As there was no difference between the two sedation techniques as regards safety, propofol sedation is probably preferred for patients undergoing ERCP procedures. However, in all of the studies that were identified only non-anaesthesia personnel were involved in administering the sedation. It would be helpful if further research was conducted where anaesthesia personnel were involved in the administration of sedation for ERCP procedures. This would clarify the extent to which anaesthesia personnel should be involved in the administration of propofol sedation.

Propofol sedation for endoscopic retrograde cholangiopancreatography (ERCP) procedures is a popular current technique that has generated controversy in the medical field. Worldwide, both anesthetic and nonanesthetic personnel administer this form of sedation. Although the American and Canadian societies of gastroenterologists have endorsed the administration of propofol by nonanesthesia personnel, the US Food and Drug Administration (FDA) has not licensed its use in this manner. There is some evidence for the safe use of propofol by nonanesthetic personnel in patients undergoing endoscopy procedures, but there are few randomized trials addressing the safety and efficacy of propofol in patients undergoing ERCP procedures. A serious possible consequence of propofol sedation in patients is that it may result in rapid and unpredictable progression from deep sedation to general anesthesia, and skilled airway support may be required as a rescue measure. Potential complications following deep propofol sedation include hypoxemia and hypotension. Propofol sedation for ERCP procedures is an area of clinical practice where discussion and mutual cooperation between anesthesia and nonanesthesia personnel may enhance patient safety.

Deep sedation with propofol, administered by anaesthesia personnel, can be used as an alternative to general anaesthesia for a select group of patients undergoing ERCP procedures. Further research is necessary to clarify the nature and parameters of deep sedation.

Which eFONA procedure has the highest first-pass success (FPS) rate is currently unknown, particularly during a 'can't oxygenate, can't oxygenate' (CICO) emergency.Smartphone technology enables 'crowdsourcing' of observational data about infrequent eFONA events. The Airway App collects anonymised first-hand details regarding eFONA procedures via a free, smartphone, or desktop application. Further details of the Airway App methodology and ethical considerations of anonymous data-gathering are previously published. 1 The data is necessarily non-verifiable, but this is a limitation of many databases of rare events.Over a 37-month period (June 16, 2016eJuly 16, 2019) the Airway App was accessed > 6000 times. Of these, 303 recorded 'report a real case'; 259 from 37 countries were judged internally consistent. The three most common themes were male patients (76%), CICO events (67%), and obstructing airway pathology (44%). In the 174 CICO emergencies, nonsurgeons undertook 88% of eFONA procedures, a supraglottic airway (SGA) was attempted in 39%, and neuromuscular block was used in 44%. eFONA FPS in non-CICO vs CICO reports were 87% and 74%, respectively (P¼0.02). Table 7 shows FPS by procedure type in both non-CICO and CICO reports. Despite eventual eFONA success in 229 reports, 15% of these patients died.In conclusion, our data suggest SGA use and patient paralysis are underutilised in CICO management despite recommendations. 2 eFONA FPS is significantly lower during CICO compared with non-CICO settings. Of all techniques used during CICO, only bougie-assisted cricothyroidotomy approached a FPS 95% lower-limit confidence interval of 80%, which the authors believe to be an acceptable eFONA FPS rate.