Use of propofol in endoscopic retrograde cholangiopancreatography

1. Use of propofol in endoscopic retrograde cholangiopancreatography Dr. Rakesh Bhandari is an assistant professor in the Department of Anesthesia and Perioperative Medicine at the University of Western Ontario, London. He is interested in the management of anesthesia care and has direct experience in the use of propofol in endoscopic retrograde cholangiopancreatography. Can you comment on intravenous propofol? How soon can the patient recover? Can they drive home? For shorter operations, such as endoscopy of upper and lower digestive tract, 25 μ g/kg/min ~ 100 μ G/kg/min propofol infusion, resulting in endoscopic amnesia of cooperative patients. In this way, you can wake up and orient within 5 to 10 minutes after stopping the infusion. Propofol can be used as one large pill and then multiple small pills according to the duration of the procedure. A typical dose of this technique is 0.5 mg/kg to 1 mg/kg body weight followed by a small intravenous dose of 10 mg to 20 mg propofol. For a short procedure lasting 5 to 10 minutes, I personally prefer to give small doses of pills as needed. It is not recommended that patients drive home after taking propofol. Is it possible for propofol to cause pain unconsciously? Yes, propofol may cause pain when the patient is unconscious, because it has no analgesic effect. Who should use propofol in the endoscope room? In the United States and other countries, there seems to be a model in which specialized nurses manage propofol. The product manual quoted from Propofol (Diprivan,AstraZeneca Canada): The American Society of Gastroenterology has requested the Food and Drug Administration to change the packaging instructions of propofol to allow people without airway management training to use it. In Canada, we do not have registered nurse anesthesiologists (CRNAs) to provide propofol management in the endoscopy room. The Canadian Association of Anesthesiologists (CAS) established an Anesthesia Assistant Working Group in 1995. The CAS guidelines state that:

2. Anesthesia assistants are usually respiratory technologists because they have airway management skills and drug use training; They will work under the direct supervision of the anesthesiologist; and Their role is supportive and does not involve independent practice. Fifteen years later, this work is still in progress, and a big question is who will pay for these positions. The working group concluded that the anesthesiologist would retain responsibility for patient care, and the anesthesiologist and the anesthesiologist assistant would work as a team to provide the best care. Due to the expanding nature of anesthesia services inside and outside the operating room, the working group also determined that there was a position of assistant in the provision of anesthesia services. CAS also believes that the independent anesthesia practice of crna has no effect. At present, there is no crna training system in canada. In addition, I want to say that if there is a serious shortage of nurses in other nursing fields, how can we expect registered nurses to take more responsibilities in different medical practice fields? From my personal experience, I think it may not be cost-effective to use the CRNA model, because an anesthesiologist performs about 2.5 to 3 CRNA workloads. This seems to be more a political issue than an actual patient care issue. I also heard that there is a saying that the licensed nurses are used for endoscopy, because there are too many patients who need upper and lower gastrointestinal examinations. Personally, as a patient, I do not want a non gastroenterologist to do endoscopy and make very important decisions that affect my life.