Expert: Dr Ian Jackson - please note UK based - 10/21/2011

Question
Hello sir, I'd like to consult you about the proper anaesthetic management for a 55 years old lady scheduled for ERCP. This patient suffering also mild hoarsness of voice & stridor due to permanent damage to both recurrent laryngeal nerve after total thyroidectomy 5 years ago. I am so worried about the airway management. Thanks a lot

Answer
Hi there
This is a difficult situation and what you do will depend on your experience. I have provided sedation for ERCP for many years now and would review the patient and explain the alternatives to her. My personal choice would be to use sedation with target controlled propofol and attempt to avoid intubation. However I would have assistance available ad all the drugs drawn up for me to convert this to a GA with intubation as my plan B.
You are half way there by being worried which is good. Just ensure you work out a plan of management with careful thought of your plan B. Then make sure that those you are working with and the patient know what these plans are.
Kind regards
Dr Jackson