Safety of non-anaesthesiologist-administered propofol sedation in ERCP

Propofol is increasingly being used for sedation purposes during endoscopic retrograde cholangiopancreatography [ERCP]. This study aimed to evaluate the safety of nonanaesthesiologist administration of propofol [NAAP] during therapeutic ERCP. 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. 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 pIace of procedure. No patients required cardiopulmonary resuscitation and admission to the intensive care unit. There were no sedation-related deaths. 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