Endoscopic retrograde cholangiopancreatography
Anesthesia type

General

Airway

ETT

Lines and access

1 PIV

Monitors

Standard ASA monitors

Primary anesthetic considerations
Preoperative

Aspiration Precautions

Intraoperative

Most patients should be considered for RSI

Postoperative
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Endoscopic approach to access the bile duct utilized to diagnose and treat liver, gallbladder, biliary, and pancreatic problems. Endoscope is inserted from the mouth to duodenum. Then the papilla of vater (Common bile duct outlet) is identified, catheterized, and injected with contrast to identify obstructions.

Overview

Indications

liver, gallbladder, biliary, and pancreatic pathology

Surgical procedure

Preoperative management

Patient evaluation

System Considerations
Airway ETT required, bite block
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other Check cervical ROM

Labs and studies

  • CBC

Operating room setup

  • Make sure you have a lead apron available
  • Have a prone pillow available and staff to help turn
  • Have bite block to facilitate scope passage available.

Patient preparation and premedication

Regional and neuraxial techniques

  • N/A

Intraoperative management

Monitoring and access

  • Standard ASA monitors

Induction and airway management

  • RSI

Positioning

  • Most patients will be prone for this procedure to aid in manipulation of scope into proper placement. If patient cannot tolerate position, lateral or supine positioning can be done (increases difficulty for proceduralist).

Maintenance and surgical considerations

General anesthesia with ETT. TIVA or volatile

Emergence

  • If obstruction in bile duct is removed, there is a high risk of bile aspiration. Have suction readily available.

Postoperative management

Disposition

Pain management

Potential complications

Pancreatitis

Cholangitis

Perforation

Procedure variants

Variant 1 Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications

References