I –GEL FOR ERCP UNDER DEEP SEDATION:OUR EXPERIENCE IN 100 PATIENTS AT TERTIARY CARE CENTER - AN RETROSPECTIVE STUDY

Abstract

Background: Use of deep sedation for ERCP is increased due to safer anaesthesia drugs and equipments. Still there are high chances of desaturation,obstructed airway ,respiratory depression requiring skilled airway support with high chances of morbidity and mortality. So we designed a multivariate study for airway management in ERCPwith I –gel under deep sedation. Aim: Gastroenterologist's procedural comfort with respiratory instability leading to desaturation requiring intervention. Objectives: Success in terms of depth of sedation, hemodynamics and recovery time. Method:100 adults of either gender, age of 20 to 60 years, ASAgrade I, II or III, MPC I or II, weight 40-80 kg for elective ERCPlasting up to 90 min were included. Premedication with Inj Glycopyrollate 0.004mg/kg ,Inj Fentanyl 1µg/kg .Inj Propofol 1mg per kg over 3 to 5 min was given and maintenance with infusion 100 µg/kg/min was started after insertion of I gel in prone position. Parameters such as number of patients having desaturation, leading to intubation gastroenterologist's procedural comfort with regard to scope insertion & manipulation and common bile duct (CBD) cannulation were recorded. Also depth of sedation,hemodynamic stability and recovery time were recorded. SPSS 20.0 was used for statistical analysis.Only frequency and percentage were calculated. Results- 1% patient had desaturation who required intubation and GA . Gastroenterologist's comfort for scope insertion was extremely easy in 62%, scope manipulation was extremely easy in 84% patients and for CBD cannulation it was extremely easy in 84% patients. Scope insertion was challenging in 3% patients who needed general anaesthesia with intubation. Depth of sedation was adequate in 94% patients and in 6% patients inadequate. Recovery time was 10-15 min in 65%patients. Conclusion : Use of I –Gel for ERCP under deep sedation signicantly decreases incidences of desaturation and emergency intubation with satisfactory gastroenterologist's comfort