The researchers assessed the safety and efficacy of sedation with a target-controlled infusion (TCI) of propofol in patients undergoing ERCP.
They reported their findings in the July issue of Gastrointestinal Endoscopy.
20 patients used the TCI system. They received oxygen at 2 L/min via nasal cannulae.
By using pharmacokinetic TCI software modeling, an initial propofol target blood concentration of 1.0 µg/mL was supplemented on patient demand with a handset. When this was pressed twice within 1 second, the concentration of propofol was increased by 0.2 µg/mL.
The maximum permissible target concentration was set at 3.0 µg/mL, to prevent over-sedation.
|Endoscopist and patient satisfaction with the procedure were high.|
16 patients used the system successfully throughout the procedure.
The propofol concentration ranged from 1.2 to 2.6 µg/mL. The number of successful handset activations (after commencement of the ERCP) ranged from 0 to 3.
In 3 patients, the ceiling propofol concentration was attained without adequate sedation, and the system was manually overridden.
The system was found to fail in 1 case because of patient confusion.
There were no episodes of hemodynamic instability, airway obstruction, or significant oxygen desaturation.
Both endoscopist and patient satisfaction were high.
The researchers found that 4 patients were over-sedated at the end of the procedure, according to their criteria. However, all were awake within 5 minutes of arrival in the recovery area.
Mike J. Gillham, of the Royal Infirmary, Glasgow, said on behalf of the group, "Patient-maintained sedation with TCI propofol was safe and fully effective in 16 patients.
"Ease of endoscopy was rated high by the endoscopists, and all patients were well satisfied with their sedation."
"Adjustments to the software programming are being evaluated to increase the safety profile to avoid over-sedation," he concluded.