Propofol use in endoscopic retrograde cholangiopancreatography and endoscopic ultrasound

Abstract

Compared to standard endoscopy, endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) are often lengthier and more complex, thus requiring higher doses of sedatives for patient comfort and compliance. The aim of this review is to provide the reader with information regarding the use, safety profile, and merits of propofol for sedation in advanced endoscopic procedures like ERCP and EUS, based on the current literature.

Patients with primary sclerosing cholangitis require more sedation during endoscopic retrograde cholangiography

“…Nevertheless, sedation is associated with potential complications, particularly cardiovascular events 13 17. At our institution, application of sedative agents for ERC is routinely performed by a gastroenterologist.…”

“…Age-related changes in the need for sedation for different endoscopic procedures are well described 13 20 21. A higher susceptibility for anesthetic drugs in elderly patients is caused by a physiological decline in hepatic volume and function, as well as decreased hepatic blood flow leading to a slower metabolism of many intravenous drugs used for anesthetic purposes 20.…”

“…However, general anesthesia is not routinely performed in Germany, is expensive and time-consuming and therefore is only performed in selected patients 12. Conscious sedation is most often applied in therapeutic ERC and is well tolerated 13. On the other hand, conscious sedation may progress to general anesthesia in a dose-dependent manner which has to be taken into account 11 13.…”

“…Conscious sedation is most often applied in therapeutic ERC and is well tolerated 13. On the other hand, conscious sedation may progress to general anesthesia in a dose-dependent manner which has to be taken into account 11 13. As PSC most often presents as progressive disease, repeated endoscopic interventions are mandatory in the majority of patients which underlines the necessity of cost-effective and efficient examinations 6 14.…”

EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV – EUS-guided Interventions: General aspects and EUS-guided sampling (Long Version)

“…The American Society of Gastrointestinal Endoscopy (ASGE) has defined several evidence-based preprocedural quality indicators, including: 1. appropriate and well-documented indication, 2. obtaining and documenting of informed consent based on the discussion of specific risks associated with the particular EUS procedure, 3. performing of preprocedure history and directed physical examination, 4. assessing and documenting of the risk for adverse events, 5. administration of prophylactic antibiotics in the setting of EUS-guided sampling of pancreatic cystic lesions (PCL), 6. monitoring and documentation of sedation, 7. proper management and documentation of antithrombotic treatment, 8. preprocedural team time-out 5 , and 9. performing of EUS by a well-trained endosonographer [64]. EUS and EUS-guided interventions are complex and lengthy procedures, more than standard endoscopy, usually requiring more patient sedation [65,66] but are often well tolerated, including in pediatric and elderly patients [67 -70]. EUS (including EBUS) can be safely performed using conscious sedation (midazolam) perhaps combined with an opioid (fentanyl or pethidine) [71 -73].…”