Patient-controlled sedation with propofol and remifentanil for ERCP: a randomized, controlled study

Area of Science:

• Gastroenterology
• Anesthesiology
• Pharmacology

Background:

• Deep sedation for ERCP often uses propofol and opioids, posing risks and potentially requiring an anesthesiologist.
• Patient-controlled sedation (PCS) with propofol and remifentanil presents an alternative sedation strategy.
• Comparative data on propofol PCS for ERCP is limited.

Purpose of the Study:

• To compare patient-controlled sedation (PCS) using propofol/remifentanil with anesthesiologist-managed propofol sedation for ERCP.

Main Methods:

• A prospective, randomized, controlled trial was conducted at a university hospital involving 80 patients undergoing elective ERCP.
• Patients were assigned to either PCS with propofol/remifentanil or anesthesiologist-managed propofol infusion.
• Sedation levels (Ramsay and Gillham scores), propofol consumption, and patient/endoscopist satisfaction were assessed.

Main Results:

• PCS was successful in 95% of patients.
• The PCS group exhibited lighter sedation and consumed significantly less propofol (175±98 mg) compared to the propofol infusion group (249±138 mg).
• Patient and endoscopist satisfaction levels were high and comparable between both groups.

Conclusions:

• Patient-controlled sedation (PCS) with propofol/remifentanil is a viable and well-accepted sedation method for ERCP.
• Anesthesiologist-managed deep sedation did not offer superior satisfaction despite higher drug use.
• Further large-scale studies are recommended to confirm the safety of PCS in ERCP patients.