A randomized controlled trial evaluating general endotracheal anesthesia versus monitored anesthesia care and the incidence of sedation-related adverse events during ERCP in high-risk patients

Smith, Zachary L.; Mullady, Daniel; Lang, Gabriel; Das, Koushik K.; Hovis, Robert M.; Patel, Riddhi S.; Hollander, Thomas; Elsner, Jeffery; Ifune, Catherine; Kushnir, Vladimir

doi:10.1016/j.gie.2018.09.001

Cited by 75 publications

(59 citation statements)

References 25 publications

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“…With regard to anesthesiologist-administered sedation, Berzin et al reported a hypoxemia rate of 12.5% and sedation-related adverse events in 21% of cases [17]. Smith et al also reported a hypoxemia rate of 9.5% and sedation-related adverse events in 19% of cases [18]. These findings concur with those of our study and indicate that sedation administered by anesthesia personnel is safer with regard to hypoxemia.…”

Section: Discussionsupporting

confidence: 91%

Sedation-related complications during anesthesiologist-administered sedation for endoscopic retrograde cholangiopancreatography: a prospective study

et al. 2020

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Background: Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) require adequate sedation or general anesthesia. To date, there is lack of consensus regarding who should administer sedation in these patients. Several studies have investigated the safety and efficacy of non-anesthesiologist-administered sedation for ERCP; however, data regarding anesthesiologist-administered sedation remain limited. This prospective single-center study investigated the safety and efficacy of anesthesiologist-administered sedation and the rate of successful performed ERCP procedures. Methods: The study included 200 patients who underwent ERCP following anesthesiologist-administered sedation with propofol and remifentanil. Procedural data, oxygen saturation, systolic blood pressure (SBP), heart rate, recovery score, patient and endoscopist satisfaction, as well as 30-day mortality and morbidity data were analyzed. Results: Sedation-related complications occurred in 36 of 200 patients (18%) and included hypotension (SBP < 90 mmHg) and hypoxemia (O 2 saturation < 90%) in 18 patients (9%) each. Most events were minor and did not necessitate discontinuation of the procedure. However, ERCP was terminated in 2 patients (1%) secondary to sedation-related complications. Successful cannulation was performed in all patients. The mean duration of the examination was 25 ± 16 min. Mean recovery time was 14 ± 10 min, and high post-procedural satisfaction was observed in both, patients (mean visual analogue scale [VAS] 9.6 ± 0.8) and endoscopists (mean VAS 9.3 ± 1.3). Conclusion: This study suggests that anesthesiologist-administered sedation is safe in patients undergoing ERCP and is associated with a high rate of successful ERCP, shorter procedure time, and more rapid post-anesthesia recovery, with high patient and endoscopist satisfaction.

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Section: Discussionsupporting

confidence: 91%

Sedation-related complications during anesthesiologist-administered sedation for endoscopic retrograde cholangiopancreatography: a prospective study

et al. 2020

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“…Of these highseverity events, 4 occurred during ERCP procedures in patients who were in the prone position when the procedure was begun, with a native airway under MAC, but who required conversion to GEA because of either hypoxia or hypoventilation. In the present study by Smith et al, 2 10% of patients in the MAC cohort were converted to GEA. Similar results were found in a study by Berzin…”

mentioning

confidence: 45%

General endotracheal anesthesia for ERCP: Don’t sleep on it!

Law

Cárdenas

2019

Gastrointestinal Endoscopy

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“…Till date, there are no formed guidelines for the standard method of care with regard to the type of anesthesia and airway management during ERCP. Zachary et al, in his study, found GA to be better than MAC regarding airway protection and other adverse events, procedural failures with higher endoscopist, patient satisfaction, and early discharge [2]. ERCP, in general, takes 1-2 h duration.…”

Section: Introductionmentioning

confidence: 98%

Efficacy of Atracurium Versus Cisatracurium in Patients Undergoing Retrograde Cholangiopancreatography Procedure Under General Anaesthesia – A Comparative Study

Sahu

Swain

Samal

et al. 2020

Asian J Pharm Clin Res

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Objectives: The objectives of the study were to compare the efficacy of injection atracurium 0.5 mg/kg intravenous (IV) versus injection cisatracurium 0.2 mg/kg IV for intubation in patients undergoing endoscopic retrograde cholangiopancreatography procedure (ERCP). Methods: Hundred adult patients of both sexes in the age group of 18–60 years belonging to the American Society of Anesthesiologists I/II category posted for ERCP procedures under general anesthesia were randomly allocated into two groups of 50 each. Group A received injection atracurium besylate 0.5 mg/kg intravenously and Group B received injection cisatracurium besylate 0.2 mg/kg intravenously. Parameters observed were time to the maximum blockade, intubating condition, time required for intubation, duration of action, hemodynamic parameters during intubation, and after 1, 2, 3, 5, and 15 min and any adverse effects. Results: Demographic profile was comparable between the groups. Intubating condition as per Cooper et al. score was excellent in 36 patients in cisatracurium group as compared to 19 patients in atracurium group. The overall intubating condition was found to be better in Group B (p=0.00001). Time to the maximum blockade was significantly high with atracurium as compared to cisatracurium. The mean of intubation time was less with cisatracurium (135±11.1) than that of atracurium (144±9.48) in seconds, which was statistically significant. Duration of neuromuscular blockade was found to be prolonged in Group B as compared to Group A (p=0.000). Hemodynamic parameters during intubation and after 1, 2, 3, 5, and 15 min were comparable between the groups. No adverse effect was seen in both groups. Conclusion: Cisatracurium 0.2 mg/kg provides excellent intubating conditions with rapid onset of action, longer duration of action, and no significant hemodynamic changes as compared with atracurium 0.5 mg/kg for ERCP procedures without any adverse effects.

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A randomized controlled trial evaluating general endotracheal anesthesia versus monitored anesthesia care and the incidence of sedation-related adverse events during ERCP in high-risk patients

Cited by 75 publications

References 25 publications

Sedation-related complications during anesthesiologist-administered sedation for endoscopic retrograde cholangiopancreatography: a prospective study

Sedation-related complications during anesthesiologist-administered sedation for endoscopic retrograde cholangiopancreatography: a prospective study

General endotracheal anesthesia for ERCP: Don’t sleep on it!

Efficacy of Atracurium Versus Cisatracurium in Patients Undergoing Retrograde Cholangiopancreatography Procedure Under General Anaesthesia – A Comparative Study

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