IS ENDOSCOPIST DIRECTED SEDATION FOR ERCP WITH BALANCED PROPOFOL SOLUTION (BPS) PRACTICAL AND SAFE? A PROSPECTIVE STUDY FROM A TERTIARY CARE CENTRE IN INDIA

Aims Endoscopist directed nurse administered sedation using propofol, midazolam and fentanyl for ERCP is being utilized worldwide. However, this is not usually employed in India by the endoscopists. The aim of this study was to assess the efficacy, acceptability and safety of this sedation in low to moderate risk patients undergoing ERCP.

Methods It was a prospective study involving 500 patients for any indication for ERCP. The sedation was given by the trained nurses.

Results Sedative dosages per patient were propofol = 90 mg ± 20 mg, Fentanyl 0.75 mg ± 0.25 mg (Range 0.25 to 1.00 mg), midazolam 2 mg ± 0.5 mg (range: 1–3 mg). 97% of patients achieved (Richmond agitation sedation score of ≥ −3 and 96.8% Gloucester comfort score of ≤ 2. 4.22% of the patients had mild adverse events(AE) and 2.11 % had moderate AE .2 (0.4%) patients required intubation and ICU admission. Mean recovery time was 15 .3 minutes. 98.3% of the endoscopists were satisfied with the sedation achieved. 31.2% of the patients remembered the procedure. 93% of the patients were satisfied with the type of sedation.

Conclusions Endoscopist directed nurse administered sedation for ERCP with BPS is easy, applicable, time saving, safe, efficient and acceptable to patients.