Introduction Propofol is widely used during endoscopy but there remains controversy around its safety, if administered by non-anaesthetists. In a review of endoscopist-administered Propofol of 600 000 patients, only four deaths were reported. Patient-controlled Propofol sedation (PCPS) has been used during ERCP with lower sedation scores reported. We therefore piloted the use of PCPS in an unselected population attending for ERCP.
Methods PCPS was used in eleven patients undergoing ERCP. Proprofol 8mg/ml and Remifentanyl 10mcg/ml was administered via a patient controlled pump, under the guidance of trained anaesthetic staff. Outcomes included completion and safety. Adverse events were defined as saturations < 90% or systolic < 90mmHg. Recovery was measured using the Aldrete score.
Results There was no difference between baseline demographics between the groups. In those undergoing PCPS, mean procedure time was significantly longer (24mins vs 40 mins, p = 0.04), althought this group tended to have more unwell patients (ASA grade) and a higher difficulty grade of ERCP (p = 0.06 and 0.05 respectively). There were no signifcant differences in frequency of adverse events between PCPS and standard sedation (p = 0.87). Also, there were no significant differences in recovery time, although Aldrete scores tended to be higher in the PCPS group. Endoscopist rating of how sedation was tolerated was significantly higher in the PCPS group (p = 0.04). 2 cases that had failed under standard sedation were subsequently completed using PCPS.
Conclusion PCPS is an effective method of sedation for ERCP. This small UK based study shows that PCPS is at least as safe as standard sedation techniques, even when used in complex procedures in severely unwell patients. In the future, with appropriate training and governance, PCPS might be utilised without anaesthetic support.
Disclosure of Interest None Declared.
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