Propofol Sedation for ERCP Procedures: A Dilemna? Observations from an Anesthesia Perspective

Abstract

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.

Use of the gastro-laryngeal tube in endoscopic retrograde cholangiopancreatography cases under sedation/analgesia

“…There is an ongoing debate about the anesthetic method that should be applied in ERCP because of the dilemma between the anesthetists' concern about airway safety and the gastroenterologists' desire for a speedy and comfortable intervention (2,3). During general anesthesia, there are issues with the need for muscle relaxants, prolonged extubation time, and instrumentation of the entire airway along with related disadvantages.…”

Effectiveness of Dexmedetomidine as an Adjunct Agent for Sedation during ERCP

“…SPO 2 and RR values were comparable between the two groups but the respiratory complications were more in propofol group. This may be rendered to the respiratory safety of dexmedetomidine and the lower amount of propofol used with it.…”

“…The patient category scheduled for ERCP procedures are usually the elderly, as the incidence of biliary complications is more frequent in the older age groups, who could be complaining of some co-morbid diseases adding additional risks to the procedure [1,2]. So cautious choice of a sedative agent, as well as monitoring of its hemodynamic effects are required.…”

Establishing an anaesthetist-delivered propofol sedation service for advanced endoscopic procedures: implementing the RCA/BSG guidelines

“…As far as we are aware, surrogate markers for complications such as 8-day readmission, 30-day mortality and length of hospital stay (for inpatients) were not increased in this group of patients. Published data also confirm a low risk of aspiration (0.10%) with propofol sedation36 and a low complication rate in ERCP patients 37. In summary, the joint RCA/BSG guidelines facilitated the establishment of a propofol sedation service with considerable benefits to patients and endoscopists.…”