Endoscopic Retrograde Cholangiopancreatography (ERCP)
Anesthesia Implications
Position: Prone, arms free at side, head to the side (facing the surgeon)
Time: 1-2 hours (average)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No
Lead: Yes
- GETT
- MAC
Check and Document Cervical ROM – Patient will lie prone with head turned to the side. Check the patient’s neck range of motion as a part of the preop assessment. If limited ROM, the patient could experience severe injury.
Avoid Opioids – These may cause the sphincter of Oddi to contract. Morphine is the biggest culprit.
Place Bite Block – ETT is placed and then the patient is rolled onto the OR bed. Have the bite block placed before rolling. Patient’s head will face the surgeon.
Check with the surgeon which side is preferred for ETT taping.
Blankets and/or wedges will elevate the same side as the surgeon and the direction the patient is facing
Glucagon – you may be asked by the surgeon to give this. 0.5 mg is a very common dose. This is designed to relax the sphincter of oddi.
Prone Position (general considerations): Maintain cervical neutrality. Keep IV’s out of the antecubital space. The patients arms are typically flexed, which will kink the IV. Eye protection should be used as the prone position heightens the risk of corneal abrasion and/or traction on the globe (which can result in blindness). Check the patients eyes/ears/nose regularly throughout the case to ensure they are free of pressure. Positioning of the leads is typically high on the posterior and posterolateral back (somewhere free of pressure and out of surgical borders). Keep your connections and tubing where you’ll have fast access.
Fluoroscopy / Xray (general considerations): Have lead aprons and thyroid shields available. Alternatively, distancing yourself 3 to 6 feet will reduce scatter radiation to 0.1% to 0.025% respectively. Occupational maximum exposure to radiation should be limited to a maximum average of 20 Sv (joules per kilogram – otherwise known as the Sievert/Sv) per year over a 5 year period. Limits should never exceed 50 Sv in a single year.
