Ambulatory surgical are increasingly undertaking complex procedures once limited to inpatient hospitals, and endoscopic retrograde cholangiopancreatography (ERCP) is one such example. We established a fast‑track anesthesia program that integrates a pre‑operative consultation clinic, a day‑surgery workflow, and a non‑intubated sedation regimen built on remimazolam and remifentanil, supported by high‑flow nasal cannula oxygen. A week prior to the procedure, patients are scheduled to anesthesia outpatient department consultation, a standardized algorithm stratifies ASA III–IV patients and triggers targeted cardiopulmonary work‑ups as well as pre‑habilitation measures such as smoking cessation and glycemic optimization. On procedure day, sedation is induced with remimazolam and remifentanil combining high‑flow nasal cannula along with advanced airway monitoring to maintain patent airway spontaneous ventilation. Depth of sedation is guided by combining BIS and density spectral array monitoring, facilitating rapid regaining of consciousness within five minutes of drug cessation. This bundled program demonstrates that rigorous pre‑operative assessment combined with remimazolam–remifentanil non‑intubated sedation can safely deliver ERCP in the ambulatory setting, yielding rapid recovery, high satisfaction, and minimal complications. The model highlights how anesthesiologists can leverage novel pharmacology, high‑flow oxygen therapy, and streamlined peri‑operative pathways to broaden the scope of ambulatory surgical services.