title: Patient-maintained sedation for ERCP with a target-controlled infusion of propofol: a pilot study.
abstract: BACKGROUND
  ERCP requires patient cooperation and often prolonged sedation. In different areas of anesthetic practice, patient-controlled sedation with a target-controlled infusion (TCI) of propofol provides effective sedation. The aim of this study was to assess the safety and efficacy of the same system in patients undergoing ERCP.
  
  
  METHODS
  Twenty patients used the TCI system. Patients received oxygen at 2 L/min via nasal cannulae. By using pharmacokinetic TCI software modeling, an initial propofol target blood concentration (Ct) of 1.0 microg/mL was supplemented on patient demand with a handset that, when pressed twice within 1 second, increased the Ct of propofol by 0.2 microg/mL. The maximum permissible target concentration was set at 3.0 microg/mL to prevent oversedation.
  
  
  RESULTS
  Sixteen patients used the system successfully throughout the procedure. The Ct propofol ranged from 1.2 to 2.6 microg/mL, and the number of successful handset activations (after commencement of the ERCP) ranged from 0 to 3. In 3 patients, the ceiling Ct propofol was attained without adequate sedation and the system was manually overridden. The system failed in 1 case because of patient confusion. There were no episodes of hemodynamic instability, airway obstruction, or significant oxygen desaturation. Endoscopist and patient satisfaction were high. Four patients were oversedated according to our criteria at the end of the procedure, but all were awake within 5 minutes of arrival in the recovery area.
  
  
  CONCLUSIONS
  Patient-maintained sedation with TCI propofol was safe and fully effective in 16 patients. Ease of endoscopy was rated high by the endoscopists, and all patients were well satisfied with their sedation. Adjustments to the software programming are being evaluated to increase the safety profile to avoid oversedation.
authors: University Department of Anaesthesia, Royal Infirmary, Glasgow, United Kingdom.
authors: M J
authors: MJ
authors: Gillham
authors: R C
authors: RC
authors: Hutchinson
authors: R
authors: R
authors: Carter
authors: G N
authors: GN
authors: Kenny
mesh_terms: D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016292:Procedural Sedation; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010349:Patient Compliance; D017060:Patient Satisfaction; D015742:Propofol / Q000493:pharmacokinetics; D012449:Safety; D016896:Treatment Outcome
chemical_list: D010100:Oxygen; D015742:Propofol