Target-controlled propofol infusion during monitored anesthesia in patients undergoing ERCP.
BACKGROUND
A target-controlled infusion system automatically adjusts the rate of infusion of propofol to maintain a desired (target) concentration. The aim of this study was to determine whether administration of propofol with a target-controlled infusion system could improve the sedation of patients undergoing ERCP.


METHODS
A total of 205 consecutive patients undergoing ERCP were sedated by using a propofol target-controlled infusion system by an anesthesiologist. The target plasma concentration of propofol ranged from 2 to 5 microg/mL. A bolus dose of fentanyl (50-100 mcg) was administered if signs of insufficient analgesia were observed at the maximum target concentration of propofol allowed. The technical difficulty of ERCP was graded on a scale from 1 (least difficult) to 5 (most difficult).


RESULTS
The mean dosages of propofol and fentanyl administered were 465 (245) mg and 59 (23) mcg, respectively. The total dose of propofol administered and the mean duration of ERCP were related to the degree of difficulty of the procedure. No severe complication was observed; mean time to discharge was 31 (12) minutes. Time to discharge was not influenced by the difficulty of ERCP or by the total dose of propofol administered.


CONCLUSIONS
A target-controlled infusion system for administration of propofol provides safe and effective sedation during ERCP. Further studies are needed to determine the cost-effectiveness and the safety profile for infusion of propofol with a target-controlled infusion system by a nonanesthesiologist during ERCP.
Division of Gastroenterology and Department of Anesthesiology and Intensive Care, Vita e Salute San Raffaele University, San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy.
Lorella
L
Fanti
Massimo
M
Agostoni
Andrea
A
Casati
Mario
M
Guslandi
Patrizia
P
Giollo
Giorgio
G
Torri
Pier Alberto
PA
Testoni
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016292:Procedural Sedation; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies
D018686:Anesthetics, Intravenous; D015742:Propofol