A Simple Technique for ERCP sedation

Started by Peter Davies M.D., June 22, 2005, 01:39:27 AM

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Peter Davies M.D.

Our hospital has recently required the use of anesthesiologists for sedation of ERCP patients. This means a lot of extra work for us that is very unpopular. The suite in which ERCPs are done is not set up for anesthesia - it is essentially a modified X-Ray room. The huge X-Ray table makes up much of the space, and access to both patient airway (at the head) and anesthesia machine/monitor (at the feet) is impossible simultaneously. Furthermore, the patient's position (semi-prone) is not ideal for airway management.

Despite the difficulties, I have developed what I consider a good technique for sedation and airway management of these patients.

Patients are sedated with a small dose of midazolam (1-3mg depending on frailty) and fentanyl (about 25mcg per 30 minutes) and then kept sedated with a propofol infusion in the range of 10-30mL/hr.

Once sedated, I place a nasopharyngeal airway in each nostril (that is, 2 N-P airways per patient). Into one, I insufflate O2, and into the other I place my CO2 sampling port. Much more effective than an oral airway or bite block for both O2 delivery and CO2 sampling. I find that I can now sedate my patients more deeply and still avoid obstruction.

Any other techniques out there?