Korean J Pancreas Biliary Tract.  2025 Apr;30(2):54-61. 10.15279/kpba.2025.30.2.54.

Appropriate Sedation for Safe Endoscopic Retrograde Cholangiopancreatography

• Jeong HT
• Kim TH

• KMID: 2567424
• DOI: http://doi.org/10.15279/kpba.2025.30.2.54

Abstract

Administering sedation for endoscopic retrograde cholangiopancreatography (ERCP) involves using medications to reduce the patient's level of consciousness during a procedure, which can alleviate patient anxiety and discomfort, and improve clinical outcomes. Due to the complexity of the procedure and physiological changes induced by the prone position, meticulous sedation management is essential during ERCP. Before the procedure, a detailed history taking and physical examination are important. If the Mallampati or American Society of Anesthesiologists classification scores are high, anesthesia provider assistance should be considered. Both standard sedation with a combination of midazolam and opioids and balanced propofol sedation can be used safely. During the procedure, monitoring of vital signs, oxygen saturation, and electrocardiogram is important. For high-risk patients, capnography should also be considered. In particular, personalized approaches, including dosage adjustments and more vigilant monitoring during the procedure, are critical for high-risk patients. To ensure safe ERCP, endoscopists must be familiar with the characteristics of sedatives, as well as the types and dosages of antagonists. To prevent hypoxia during the procedure, preoxygenation and the use of high-flow nasal cannula can be considered, and a laryngeal mask can be useful if intubation is difficult in emergency situations. Above all, care must be taken to avoid excessive doses of sedatives, and it is crucial to continually assess the necessity of ERCP for each patient.

Keyword

Endoscopic retrograde cholangiopancreatography; Sedation; Midazolam; Propofol; 내시경역행성췌담관조영; 진정; 미다졸림; 저산소증