Deep sedation for endoscopic retrograde cholangiopancreatography: intravenous propofol alone versus intravenous propofol with oral midazolam premedication

Abstract

Our data suggest that synergistic sedation with an oral dose of midazolam combined with intravenous propofol can provide a significant benefit, with a reduction in the dosage of propofol required and in patient anxiety levels before ERCP.

Safety and Prevention of Complications in Endoscopic Sedation

“…However, the safety and efficacy of propofol for routine endoscopic procedures when administered by endoscopists as well as anesthesiologists have been reported in multiple trials [11][12][13]. In addition, there are data supporting the safe use of propofol for advanced endoscopic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and/or endoscopic ultrasound (EUS) [14][15][16][17][18][19]. The incidences of complications, such as hypoxemia, bradycardia, and the need for airway intervention were not different between propofol and standard sedatives in previous studies.…”

“…Although many previous studies examined measurements of hemodynamic changes during endoscopic procedures [14,15,17,27,[31][32][33][34], few have given detailed descriptions of quantitative changes in hemodynamic parameters and oxygen saturation during endoscopic sedation. There are also no reports regarding the frequency of cough during endoscopic procedures performed under sedation.…”

Continuous propofol and bolus propofol result in similar sedative use during endoscopic retrograde cholangiopancreatography: A retrospective study

“…Due to its rapid recovery profile, the use of propofol has increased for many endoscopic procedures over the last decade [10][11][12][13][14]. Propofol produces safe, effective, and well-tolerated sedation [15].…”

“…Midazolam and propofol have been shown to act synergistically, and the dose of propofol can be reduced when used in combination with midazolam [10]. Propofol can be administered as a continuous infusion or an intermittent bolus.…”

Efficacy and safety of a patient-positioning device (EZ-FIX) for endoscopic retrograde cholangiopancreatography

“…Thus, it is recommended that propofol should be administered only by anesthesia specialists [14] . Although a large volume of data shows the safety of endoscopistdirected propofol [15][16][17][18][19][20][21][22][23] , it is important to be aware of sedation-related complications due to the increase in the number of elderly patients with multiple underlying comorbidities and its nature as an advanced endoscopic technique that demands longer procedure times and deeper sedation. In clinical practice, it is common to combine propofol with additional drugs (benzodiazepine/opioid/ketamine), so-called "balanced propofol sedation" (BPS), which allows the propofol dose to be reduced and seems to be associated with less-frequent need for assisted ventilation, although this has not been demonstrated in head-to-head comparisons [23][24][25][26][27] .…”