Anaesthesia for endoscopy and ERCP

Meet the patient

A 78-year-old with ascending cholangitis is wheeled to the endoscopy suite at 22:00 for urgent ERCP. She is septic, not reliably fasted, in atrial fibrillation and heart failure, and she will lie semi-prone. The trainee suggests "just a little propofol sedation to get the list moving." The fellowship answer is a structured triage — and in this woman, that triage is general anaesthesia with a cuffed tracheal tube, not deep sedation.^[1]

The two questions that decide every endoscopy case are the two the trainee skipped: can I rescue this airway in the dark, prone, far from theatre? and what happens to her oxygenation and blood pressure if the depth I choose abolishes her reflexes? Hold those two and the triage writes itself.^[1]

References3ShowHide

1. [1]Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery Circulation, 1999.PMID 10477528
2. [2]Devereaux PJ, Yang H, Yusuf S, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial Lancet, 2008.PMID 18479744
3. [3]Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial Lancet, 2010.PMID 20554319