Projects

Endoscopic retrograde cholangiopancreatography has diverse diagnostic and
therapeutic applications, enabling treatment of biliopancreatic diseases. The newest
advancement- SpyGlass™ cholangioscopy, allows single operator use to visually
examine the biliary ducts, take biopsy samples, and treat large biliary stones by either
electrohydraulic or laser lithotripsy. While this advancement is minimally invasive,
it causes pain and discomfort to patients. Anesthesia helps improve tolerance,
cooperation, and patient comfort with successful outcomes. Propofol delivered as
a target-controlled infusion (TCI) titrated with bispectral index (BIS) monitoring with
a combination of transnasal humidified rapid insufflation and ventilatory exchange
(THRIVE) for oxygenation offers minimal perioperative airway manipulation,
hemodynamic stability, and better recovery. SpyGlass™ cholangioscopy done
with TCI propofol and THRIVE is quicker to perform, provides adequate space for
the endoscopist to perform the procedure, improves turnover of cases, and better
utilization of hospital resources, especially in a busy endoscopy room, away from
the regular operation theater. This case series describes the anesthetic management
of four patients with varied demographic and medical profiles who underwent
SpyGlass™ cholangioscopy for cholelithiasis. Sedation was achieved using TCI
propofol and THRIVE, titrated through BIS monitoring, alongside the interactive
total intravenous anesthesia Mobile application (iTIVA) to track pharmacokinetics
and effect-site concentrations. All patients remained hemodynamically stable, with
preserved airway reflexes and oxygenation throughout. TCI propofol sedation with
THRIVE and appropriate monitoring emerges as an optimal approach for SpyGlass
cholangioscopy, offering shorter recovery, fewer airway complications, and faster
turnover compared to conventional techniques.
Key words: Apnoeic oxygenation; Preoxygenation; High-flow nasal oxygenation