Comparative Study Of Continuous Infusion With Intermittent Bolus Of Propofol During ERCP Using Laryngeal Mask Airway®Gastro™

After getting approval from  Institutional Ethical Committee (IEC), those patients who are fit in inclusion criteria will be included in our study and written and informed consent will be taken.

Patient will be randomized in two groups, (40 in each group)  using computer generated random number table.

Group CI – Continuos infusion of propofol using LMA®Gastro™

Group IB – Intermittent Bolus injection of propofol using LMA®Gastro™.

After shifting the patient to endoscopy room, patient will be asked to lie down  supine with head in sniffing position. ASA monitors will be attached. Baseline values of heart rate(HR), systolic blood pressure(SBP),diastolic blood pressure(DBP), and oxygen saturation will be recorded. Patient will be preoxygenated with 100% oxygen for 3 minutes.

Patient will be premedicated with 0.05mg/kg midazolam, 2mcg/kg fentanyl and 0.01mg/kg glycopyrrolate.

In the CI group,  infusion  of propofol will be started at 9-12 mg/kg/hr. Depth of anaesthesia will be assessed by loss of eyelash reflex/verbal contact. After induction, the infusion rate will lowered to the range of 2-5 mg/kg/hr then titrated by 1-2mg/kg/hr to maintain adequate sedation.

In the IB group, patient will be given  intravenous injection bolus 2mg/kg propofol, followed by additional small boluses of 10-20 mg propofol every 30-60 secs to maintain adequate sedation.

Induction time (in minutes) and Total Propofol used for induction (in mg) will be recorded.

Standard insertion technique will be used to insert the LMA®Gastro™ and endoscope, insertion will be performed by an experienced anaesthesiologist and the ease of insertion of the LMA®Gastro™ (Jaw Relaxation, Gagging,Cough,Patient Movement)[10], first attempt success rate of LMA®Gastro™ insertion will be recorded,

Time to insert endoscope via LMA®Gastro™, and Ease of endoscope insertion as rated by gastroenterologist (graded as easy or difficult) will be recorded.

Successful insertion of LMA®Gastro™ was defined by a square wave pattern capnography, symmetrical chest wall expansion and the absence of an audible oral air leak with a cuff pressure between 0-40 cmH20(Yellow zone). If insertion will not successful after two attempts, the trachea will be intubated using direct laryngoscopy and the patient will be excluded from the analysis.

Patient will be ventilated by intermittent  positive pressure ventilation in  supine/ lateral  position. At the end of procedure, the LMA®Gastroâ„¢ will be removed.

The recovery time was defined as the time from stopping propofol till the patient is conscious, alert, obeying command and the airway protective reflexes have returned. Recovery time for successful extubation (in minutes) will be recoded.

Any adverse event like postoperative nausea vomiting ,hypotension, bradycardia,  will be recorded till discharge from PACU.