Sedation in ERCP

There are several unique considerations when preparing to sedate a patient for for endoscopic retrograde cholangiopancreatography (ERCP). Most endoscopists prefer to position the patient in the prone position. Because monitoring chest movement is particularly difficult in this circumstance, the use of capnography (end-tidal carbon dioxide (ETCO2) is recommended. The patient should be monitored by a health care provider who is not otherwise responsible for executing the procedure (e.g., an anesthesiologist, nurse anesthetist, or registered nurse). Sedation should be administered by a provider who is trained in the sedation continuum; patients undergoing ERCP require a depth of sedation ranging from moderate sedation to general anesthesia. In the US, if the targeted level of sedation is deep sedation or greater, a provider trained in the administration of anesthesia should be used. Consistent with other endoscopic procedures, there is an increasing trend to use an anesthesia provider for the administration of sedation during ERCP. Prior to ERCP, the team of providers should carefully assess the patient's risk for a sedation-related adverse event. This includes an understanding of the procedure's anticipated intensity and duration, which will inform the optimal approach to administering sedation (e.g., use of an endotracheal tube). Room setup and other considerations for patient and provider safety are essential, including the use of appropriate protective equipment for radiation safety. The provider whose sole responsibility is to monitor the patient during sedation should have visual and physical access to the patient's airway at all times.