title: Safety of non-anaesthesiologist-administered propofol sedation in ERCP.
abstract: OBJECTIVE
  Propofol is increasingly being used for sedation purposes during endoscopic retrograde cholangiopancreatography (ERCP). This study aimed to evaluate the safety of non-anaesthesiologist administration of propofol (NAAP) during therapeutic ERCP.
  
  
  METHODS
  Patients, who underwent ERCP at Centre for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi, were included in the study. Propofol sedation was administered by a physician who was a non-anaesthesiologist certified in basic and advanced cardiac life support. The total study duration was 6 months. The primary outcome variable was the frequency of any sedation-related complication.
  
  
  RESULTS
  A total of 156 patients (41% males and 59% females) were enrolled in the study. The mean propofol dose used during the procedure was 201±132 mg. The mean propofol dose, when adjusted to weight and duration of procedure, was 0.05±0.04 mg kg(-1)min(-1). According to the American Society of Anesthesiologists (ASA) classification, 136 (87%) patients were placed in ASA class I and II and 20 (13%) patients were of ASA class III. Only two patients developed sedation-related complication: one minor requiring bag-mask ventilation and other major requiring mechanical ventilation via endotracheal intubation. Both were managed by the trained non-anaesthesiologist and gastroenterologist at the place of procedure. No patients required cardiopulmonary resuscitation and admission to the intensive care unit. There were no sedation-related deaths.
  
  
  CONCLUSIONS
  NAAP sedation can be considered safe for low-risk patients (ASA class I and II) undergoing ERCP. The presence of a trained anaesthetist is advisable in high-risk patients (ASA class III and higher) with significant co-morbidities.
authors.affiliation: Center for Liver and Digestive Diseases, Holy Family Hospital, F-block Satellite Town, Rawalpindi 46000, Pakistan.
authors.forename: Haider Ali
authors.initials: HA
authors.lastname: Khan
authors.affiliation: Center for Liver and Digestive Diseases, Holy Family Hospital, F-block Satellite Town, Rawalpindi 46000, Pakistan. Electronic address: drumarpk@yahoo.com.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Umar
authors.affiliation: Center for Liver and Digestive Diseases, Holy Family Hospital, F-block Satellite Town, Rawalpindi 46000, Pakistan.
authors.forename: Hamama
authors.initials: H
authors.lastname: Tul-Bushra
authors.affiliation: Center for Liver and Digestive Diseases, Holy Family Hospital, F-block Satellite Town, Rawalpindi 46000, Pakistan.
authors.forename: Gul
authors.initials: G
authors.lastname: Nisar
authors.affiliation: Army Medical College, Rawalpindi, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Bilal
authors.affiliation: Shifa International Hospital, Islamabad, Pakistan.
authors.forename: Shifa
authors.initials: S
authors.lastname: Umar
mesh_terms: D000328:Adult; D022561:Advanced Cardiac Life Support / Q000193:education; D000368:Aged; D000776:Anesthesiology; D002568:Certification; D002760:Cholangiopancreatography, Endoscopic Retrograde; D054810:Deep Sedation / Q000009:adverse effects* / Q000379:methods; D004502:Education, Medical, Continuing; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010819:Physician's Role; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects*; D012121:Respiration, Artificial
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol
keywords: Endoscopic retrograde cholangiopancreatography (ERCP); Non-anaesthesiologist administered propofol (NAAP); Propofol