ERCP (Endoscopic retrograde cholangiopancreatography)
- Access
- PIV x1
- Airway
- GA Oral ETT (with standard induction Lidocaine/Propofol/Rocuronium (and a little fentanyl to blunt sympathetic surge). Or MAC (use cautiously).
- Induction
- Lidocaine/Propofol.
- Maintenance
- Either MAC Propofol PRN, Propofol gtt. Recommend high flow nasal cannula since difficult to mask ventilate in that position.
- Emergence
- Awake
- Antibiotics
- None
- Position
- Sloppy prone with patient R side slightly up, head to the right
Notes
ETT taped to the left. Pre turn head to the right and then flip from supine to prone. Arms may be crossed in advance if needed.
CO2 insufflation will cause CO2 to rise, but keep Malignant Hyperthermia on Ddx.