Patient-controlled sedation with propofol and remifentanil for ERCP: a randomized, controlled study

Background: Deep sedation with propofol and an opioid is commonly used for ERCP but is associated with increased risk and may require the presence of an anesthesiologist. Delivery of propofol and a short-acting, potent opioid analgesic remifentanil by patients to themselves (patient-controlled sedation, PCS) could be another option. Comparative studies with propofol PCS for FRCP are lacking. Objective: To compare PCS with propofol/remifentanil to anesthesiologist-managed propofol sedation. Design: Prospective, randomized, controlled human trial. Setting: University hospital. Patients: This study involved 80 patients presenting for elective ERCP. Intervention: Patients were randomized to PCS with propofol/remifentanil (PCS group) or anesthesiologist-managed propofol sedation (propofol infusion group). Sedation level was estimated every 5 minutes throughout the procedure by using Ramsay and Gillham sedation scores. The total,amount of propofol was calculated at the end of the procedure. Endoscopist and patient satisfaction with the procedures was evaluated with a structured questionnaire. Main Outcome Measurements: Patient vital signs, amount of consumed propofol, sedation levels, and degree of endoscopist and patient satisfaction. Results: PCS was successful with 38 of 40 (95%) ERCP patients. In the PCS group, the mean (+/- standard deviation) level of sedation was markedly lighter and propofol consumption significantly smaller (175 +/- 98 mg) than in the propofol infusion group (249 +/- 138 mg) (P < .01). Degrees of patient and endoscopist satisfaction were equally high in both groups. All of the patients preferred the same sedation method should a repeat ERCP be required. Limitations: Single-center study. Conclusion: PCS with propolol/remifentanil is a suitable and well-accepted sedation method for ERCP. Anesthesiologist-managed propofol sedation with constant propofol infusion is associated with unnecessary deep sedation without any impact on the degree of patient or endoscopist satisfaction. Further larger-scale studies are needed to assess the safety of PCS in ERCP patients. (Clinical trial registration number: NCT01079312.) (Gastrointest Endosc 2011;73:260-6.)