Endoscopic retrograde cholangiopancreatography (ERCP)는 진단 내시경과 유사한 진정법이 사용되지만 시술의 복잡성, 질환 특성, 환자의 자세 등으로 인해 진정 관련 우발증 위험이 높아 고위험 시술로 분류된다. 시술 전 병력청취와 신체 검진을 통해 Mallampati 또는 American Society of Anesthesiologists 분류가 높을 경우 마취과 협진을 고려해야 한다. 미다졸람과 아편 유사제 병합 또는 프로포폴 기반 균형 진정은 모두 안전하게 사용 가능하며, 시술 중 활력 징후, 산소포화도, 심전도 모니터링이 필요하다. 고위험군에서는 호기말 CO2 측정을 추가할 수 있고 고유량 비강 캐뉼라, 후두 마스크 등도 고려된다. 진정제 과량 투여를 피하고 ERCP의 적응증을 신중히 검토하는 것이 중요하다.

Administering sedation for endoscopic retrograde cholangiopancreatography (ERCP) involves using medications to reduce the patient's level of consciousness during a procedure, which can alleviate patient anxiety and discomfort, and improve clinical outcomes. Due to the complexity of the procedure and physiological changes induced by the prone position, meticulous sedation management is essential during ERCP. Before the procedure, a detailed history taking and physical examination are important. If the Mallampati or American Society of Anesthesiologists classification scores are high, anesthesia provider assistance should be considered. Both standard sedation with a combination of midazolam and opioids and balanced propofol sedation can be used safely. During the procedure, monitoring of vital signs, oxygen saturation, and electrocardiogram is important. For high-risk patients, capnography should also be considered. In particular, personalized approaches, including dosage adjustments and more vigilant monitoring during the procedure, are critical for high-risk patients. To ensure safe ERCP, endoscopists must be familiar with the characteristics of sedatives, as well as the types and dosages of antagonists. To prevent hypoxia during the procedure, preoxygenation and the use of high-flow nasal cannula can be considered, and a laryngeal mask can be useful if intubation is difficult in emergency situations. Above all, care must be taken to avoid excessive doses of sedatives, and it is crucial to continually assess the necessity of ERCP for each patient.

서 론
본 론
    1. 진정 약물
    2. ERCP 전 준비
    3. 진정 내시경
    4. 저산소증
    5. 퇴실
결 론
요 약
ORCID
REFERENCES

• 정한택(대구가톨릭대학교 의과대학 내과학교실) | Han Taek Jeong (Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu)
• 김태현(원광대학교 의과대학 내과학교실) | Tae Hyeon Kim (Division of Biliopancreas, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea) Corresponding author