ERCP in Radiology

Updated March 29, 2013
Author: Tom VerLee, with input from KSP & RFl

Description: Anesthetic Management for ERCPs in the Radiology Sector


Endoscopic Radiologic CholangioPancreatography (ERCP) in Xray:

This will be updated in September 2012 when the New ERCP Unit opens.

Preop: Patients can be seen In the endo preop area outside the Endoscopy Suite. They will be NPO for several hours, and ASU will usually start an IV. Blank paperwork is in bottom drawer of the anesthesia cart.

Operative Management:

Most patients can be done with IV deep sedation/anesthesia and spontaneous ventilation.

Equipment and Supplies:

The Endo Suite contains a:

  • Bluebell cart, fully stocked with drugs, propofol, a Bard infusion pump, tubing, airway equipment, and IV parts.
  • Compact Narkomed anesthesia machine & ventilator.
  • standard Hewlett-Packard full monitor setup, with EPIC integration.
  • Pyxis drug dispenser; Versed and fentanyl are available for the asking.

A Suggested Approach:

  1. Nasal prongs O2, with ETCO2 sampling
  2. IV from ASU or you place for inpatients
  3. Monitors: BP, SpO2, EKG
  4. Let patient position themselves: prone or ¾ lateral, left arm at side, right arm up, head on small pad.
  5. "Premed"= fentanyl 25-50 mcg (blunts gag reflex)
  6. put Bite Block in before starting propofol
  7. Propofol bolus (20-50 mg) & infusion: 75-150 mcg/kg/min 8) Intermittent glucagon boluses per operator request (decreases GI motility). They'll draw it up, you give it.
  8. Occasional oral suction is necessary; they have dentist-office type suckers which work great.

Recovery:

Most patients wake up shortly after the propofol infusion stops, especially if they have received little-no Versed. They may then move themselves to the stretcher, and you can provide face mask O2 while you transport them to Radiology PACU.

Comments

A. I have had 3 patients (elderly) that required neosynephrine infusions to maintain adequate Blood Pressure on a propofol infusion.

B. GE Reflux is not necessarily a contraindication to this technique. The prone position helps maintain a clear airway, and once the endoscope is in the stomach, it is decompressed. You could also argue that an endoscope in the stomach makes Everyone's sphincter incompetent.

C. Some patients, esp. the obese, may obstruct their airways even in the prone position. I have used an LMA in these cases with success (placing it while the patient is prone). The gastroscope can easily be passed around the LMA by temporarily deflating the cuff, and then re-inflating.

Other Info:

Endo Suite Phone No.: x3590

Endo Office Door Code: 2135

Endo Techs: Michelle, Caroline, Karen, Cindy, Stephanie GI Endo Fellow