Anesthesiologist-managed sedation for endoscopic retrograde cholangiopancreatography: Experience at the University of Hong Kong Shenzhen Hospital

Abstract

Providing sedation and analgesia to patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is challenging because of patient position, procedure duration, and depth of sedation required. Conventionally, sedation for ERCP is managed by endoscopists with intravenously administered benzodiazepines and opioids. With increasing complexity of ERCP procedures, there is a trend to involve anesthesiologists to provide sedation and anesthesia. Anesthesiologists are able to provide general anesthesia in failed sedation. Moreover, patients at high risk of aspiration should be identified, and general anesthesia with endotracheal intubation would be a recommended approach in these patients. Anesthesiologists are also experienced in using potent and short-acting intravenous sedation and in management of cardiovascular and respiratory adverse events that arise from sedation. Use of short-acting sedatives would enhance recovery from ERCP. We discuss our experience with sedation for ERCP at the University of Hong Kong Shenzhen Hospital.