1Department of Upper GI and Pancreatico-Biliary Surgery

Royal Infirmary, Glasgow G31 2ER

Background: Endoscopic retrograde cholangiopancreatography (ERCP) requires good patient cooperation and often prolonged sedation. In anaesthetic practice, patient-controlled sedation (PCS) using a target-controlled infusion (TCI) of propofol is an effective method of providing sedation. The aim of this study was to assess the safety and efficacy of the same system for patients undergoing ERCP procedures.

Methods: 20 patients undergoing ERCP used the sedation system. Patients received 2L/min oxygen via nasal cannulae. An initial selected Ct propofol of 1.0 mcg/ml was supplemented on patient demand, using a handset which when pressed twice within one second increased the Ct of propofol by 0.2 mcg/ml. The maximum permissible Ct was set at 3.0 mcg/ml to prevent oversedation. Heart rate, blood pressure, oxygen saturation and sedation score were recorded.

Results: Sixteen patients used the system successfully throughout the procedure. The Ct propofol ranged from 1.2-2.6 mcg/ml, and the number of successful handset activations (following commencement of the ERCP)ranged from 0-3. In three patients, the ceiling Ct propofol was attained without adequate sedation and the system was manually overridden. One patient failed because of confusion. There were no episodes of haemodynamic instability, airway obstruction or significant oxygen desaturation in any of the patients studied. Endoscopist and patient satisfaction were high. Four patients were technically oversedated at the end of the procedure but all were awake within 5 minutes of arrival in the recovery room.

Conclusions: Patient-controlled sedation with TCI propofol was safe in the 20 patients studied, fully effective in 16 patients and popular with both the endoscopist and the patients.