Background and Goal of Study: Propofol is a short-acting, intravenously administered agent with a rapid recovery profile and good amnesic effects. Use of a target-controlled infusion (TCI) system for administration of propofol allows rapid induction and safe maintenance of the desired level of sedation, thereby making it ideal for technically demanding procedures (1). The aim of this study was to determine whether administration of propofol with a target-controlled infusion system BIS titrated could improve the sedation of patients undergoing ERCP.
Materials and Methods: We studied 150 consecutive patients undergoing ERCP in prone position. The patients were sedated by using a propofol target-controlled infusion system (Alaris Diprifusor) BIS-titrated. All patients were spontaneously breathing an oxygen-enriched mixture through the nasal cannula. The target plasma concentration of propofol ranged from 2 to 5 mcg/mL with a target BIS value ranged from 40 to 65. 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, and always after sfinterotomy.
Results and Discussions: The mean dosages of propofol and fentanyl administered were 560 mg and 60 mcg, respectively. No severe complication was observed; mean time to discharge was 20 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 BIS titrated 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 non-anaesthesiologist during ERCP.
1 Fanti L. Gastrointest Endosc 2004;60:361-6.