Is endoscopist-directed sedation for endoscopic retrograde cholangiopancreatography with balanced propofol solution (BPS) practical and safe? A prospective study from a tertiary care centre in India.

Abstract

IntroductionEndoscopist-directed, nurse-administered sedation using propofol, midazolam, and fentanyl for endoscopic retrograde cholangiopancreatography (ERCP) is being utilized worldwide. However, this is not usually employed in India by endoscopists.AimTo assess the efficacy, acceptability, and safety of this sedation in low to moderate risk patients undergoing ERCP.Material and methodsThis was a prospective study involving 500 patients with any indication for ERCP. The sedation was given by trained nurses.ResultsThe sedative dosages per patient were as follows: propofol = 90 ±20 mg, fentanyl 0.75 ±0.25 mg (range: 0.25–1.00 mg), and midazolam 2 ±0.5 mg (range: 1–3 mg). Ninety-seven percent of patients achieved Richmond agitation sedation score of ≥ –3, and 96.8% achieved Gloucester comfort score of ≤ 2. 4.22% of the patients had mild adverse events (AE), and 2.11% had moderate AE. Two (0.4%) patients required intubation and intensive care unit admission. Mean recovery time was 15.3 min. 98.3% of the endoscopists were satisfied with the sedation achieved. 31.2% of the patients remembered the procedure. 93% of the patients were satisfied with the type of sedation. 92.75% of ERCPs were successful. 7.59% had procedure-related complications: in the form PEP – 5.290%, significant bleeding – 1.08%, and perforation – 0.43%.ConclusionsEndoscopist-directed, nurse-administered sedation for ERCP with balanced propofol solution is practical, efficient, time saving, safe, and acceptable to patients.