Correlation of Pre-Procedural Anxiety on Propofol Consumption in Patients Undergoing Endoscopic Retrograde Cholangiopancreatography

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure that requires patient cooperation, making appropriate sedation essential. Propofol is routinely used for sedation in ERCP. Anxiety is an unpleasant feeling of apprehension, irritability, and strain that results in a dramatic neuroendocrine response, causing hemodynamic and metabolic changes due to increased sympathetic activity with catecholamine and cortisol secretion. This study aims to evaluate the effects of pre-procedural anxiety on propofol consumption and recovery in patients undergoing ERCP.
Materials and Methods: After approval from the institutional ethics committee, this study was conducted in 63 adult patients scheduled to undergo ERCP under sedation. After obtaining informed consent, patients satisfying the inclusion criteria were enrolled. They completed the Beck Anxiety Inventory (BAI) questionnaire, which includes 21 descriptive statements (with a total score ranging from 0 to 63), prior to the procedure, and the total score was recorded. The propofol requirement was expressed as the average propofol infusion rate.
Results: Patients with a minimal Beck Score had an average propofol infusion rate of 122.4±45.76 µg/kg/min; those with a mild Beck score had 172.78±54.86 µg/kg/min; those with a moderate Beck score had 205±56.33 µg/kg/min; and those with a severe Beck score had 258.75±42.24 µg/kg/min. There was a strong positive correlation between BAI score and average propofol infusion rate  (r = 0.750, p < 0.001). The mean recovery time was 8.03 ± 2.14 minutes. 
Conclusion: Higher levels of pre-procedural anxiety are significantly associated with increased propofol consumption in patients undergoing ERCP under sedation. Assessment of anxiety in the pre-procedural period may help optimize anaesthetic management.