With over 500,000 endoscopic retrograde cholangiopancreatography (ERCP) performed every year in the USA alone, the anesthesia aspects warrant a new appraisal. Along with increasing numbers, the complexity of the procedures and morbidity of the patient population has increased. Yet, the anesthesia/sedation methods are poorly standardized and the physio-anatomical factors are not always taken into account. The current review is an attempt to discuss the myriad of variables that need to be understood and applied to provide safe sedation for ERCP. Along with relevant anatomy and physiology of pancreatiocobiliary tree, the systemic effects of ongoing pathology are highlighted. Importance of preoperative evaluation and the specific areas of relevance for safe ERCP sedation are discussed. While planning for the ERCP rooms, due consideration should be given to aspects like type and location of monitoring systems, use of mobile anesthesia carts, type of airway equipment, anesthesia work station and breathing systems. Authors preferred technique and a brief discussion of post procedural sedation issues are mentioned. Table 19.1 provides a summary of anesthesia considerations in patients undergoing ERCP.
KeywordsERCP Deep sedation Anesthesia Propofol MAC
Conflicts of Interest
Funding and Conflicts of interest—none.
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