Cardiopulmonary complications of ERCP in older patients

Fisher, Leon; Fisher, Alexander A.; Thomson, Andrew

doi:10.1016/j.gie.2005.09.020

Cited by 97 publications

(92 citation statements)

References 33 publications

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“…Rate pressure product (RPP) and pressure-rate quotient (PRQ) (12), which are two indices that reflect myocardial oxygen consumption, were calculated following the examination as follows: RPP = systolic blood pressure (SBP) x heart rate (HR) / 1,000; PRQ = mean arterial pressure / HR.…”

Section: Methodsmentioning

confidence: 99%

“…3). It has been suggested that RPP ≥12 indicates myocardial ischemia (12), and that RPP ≥20 is a threshold for angina pectoris; PRQ <1.0 is considered to be an accurate measure of myocardial ischemia. In the present study, 1 patient had a very high RPP (>20), and 2 patients had PRQ <1.0, in group P.…”

Section: Combined Use Of Propofol and Etomidate Reduces Recovery And mentioning

confidence: 99%

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Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study

Meng

Cao

Liu

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study is to compare the safety, efficacy and cost effectiveness of anesthetic regimens by compound, using etomidate and propofol in elderly patients undergoing gastroscopy. A total of 200 volunteers (65-79 years of age) scheduled for gastroscopy under anesthesia were randomly divided into the following groups: P, propofol (1.5-2.0 mg/kg); E, etomidate (0.15-0.2 mg/kg); P+E, propofol (0.75-1 mg/kg) followed by etomidate (0.075-0.1 mg/kg); and E+P, etomidate (0.075-0.01 mg/kg) followed by propofol (0.75-1 mg/kg). Vital signs and bispectral index were monitored at different time points. Complications, induction and examination time, anesthesia duration, and recovery and discharge time were recorded. At the end of the procedure, the satisfaction of patients, endoscopists and the anesthetist were evaluated. The recovery (6.1±1.2 h) and discharge times (24.8±2.8 h) in group E were significantly longer compared with groups P, P+E and E+P (P<0.05). The occurrence of injection pain in group P+E was significantly higher compared with the other three groups (P<0.05). In addition, the incidence of myoclonus and post-operative nausea and vomiting were significantly higher in group P+E compared with the other three groups (P<0.05). There was no statistical difference among the four groups with regards to the patients' immediate, post-procedure satisfaction (P>0.05). Furthermore, there was no difference in the satisfaction of anesthesia, as evaluated by the anesthetist and endoscopist, among the four groups (P>0.05). The present study demonstrates that anesthesia for gastroscopy in elderly patients can be safely and effectively accomplished using a drug regimen that combines propofol with etomidate. The combined use of propofol and etomidate has unique characteristics which improve hemodynamic stability, cause minimal respiratory depression and less side effects, provide rapid return to full activity and result in high levels of satisfaction.

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Section: Methodsmentioning

confidence: 99%

Section: Combined Use Of Propofol and Etomidate Reduces Recovery And mentioning

confidence: 99%

Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study

Meng

Cao

Liu

et al. 2016

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

show abstract

“…Questions relating to procedure assessment should be included on the board examination and should reflect a general knowledge of this content (70)(71)(72)(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85).…”

Section: Assessment Of Competencymentioning

confidence: 99%

Multisociety Sedation Curriculum for Gastrointestinal Endoscopy

Vargo¹,

DeLegge²,

Feld³

et al. 2012

Am J Gastroenterol

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“…Fisher et al (16) reported that myocardial injury was observed in 8% of procedures after ERCP, as evidenced by an elevation in serum cardiac troponin-I, and that myocardial ischemia might be associated with post-ERCP pancreatitis. In contrast, on the basis of serum cardiac troponin-T concentrations, Martin et al (17) found that myocardial ischemia during ERCP was transient, without progression into myocardial damage, and was not associated with clinical outcome.…”

Section: Introductionmentioning

confidence: 99%

Role of serum myeloperoxidase, CPK, CK-MB, and cTnI tests in early diagnosis of myocardial ischemia during ERCP

Yıldız

İnce²,

Kemik³

et al. 2014

Turk J Gastroenterol

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Background/Aims: Some patients may experience retrosternal pain during ERCP, which may be a pioneer of a serious myocardial problem, and early diagnosis is very important for the prognosis and management. In the study, we aimed to investigate the role of serum cardiac biomarkers, such as myeloperoxidase (MPO), creatine phospokinase (CPK), creatine kinase-myocardial band (CK-MB), and cTnI, on early diagnosis of myocardial ischemia during endoscopic retrograde cholangio pancreaticograpy (ERCP) procedures. Materials and Methods: In this prospective observational study, ERCP patients were separated into ischemic cardiac (n:48) and non-ischemic (n:76) groups. Serious cardiac, kidney, and liver disease patients were excluded from the study. Changes in electrocardigrapy (ECG), blood pressure, pulse rate, oxygen saturation, and serum MPO, CPK, CK-MB, and cTnI levels were investigated before and after the ERCP. Results were evaluated statistically (p<0.05). Results: Mean age was 59.76±16.62 (55♀, 69♂). Only one patient had clinically unimportant retrosternal pain (0.8%). ST-elevation was detected in 10.4% (n:5), ST-depression in 12.5% (n:6), and negative-T in 31.3% (n:15) of ischemic patients during ERCP. Systolic and diastolic blood pressure and pulse rates in both groups and oxygen saturations in the ischemic group were reduced after ERCP. Significance was not detected with MPO and CPK tests. CK-MB levels showed an increase after the ERCP in the non-ischemic group (p<0.001). cTnI means were higher among the ischemics when pre-and post-ERCP periods (p:0.001) were compared. Conclusion: Clinically unimportant retrosternal pain, T negativity, and ST segment changes as well as reduced systolic, diastolic blood pressure, and heart rates can be seen during ERCP. MPO and CPK levels remain insignificant if myocardial injury does not develop. Increased CK-MB levels in non-ischemic patients and increased cTnI levels in ischemics may be seen.

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Cardiopulmonary complications of ERCP in older patients

Cited by 97 publications

References 33 publications

Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study

Safety and efficacy of etomidate and propofol anesthesia in elderly patients undergoing gastroscopy: A double-blind randomized clinical study

Multisociety Sedation Curriculum for Gastrointestinal Endoscopy

Role of serum myeloperoxidase, CPK, CK-MB, and cTnI tests in early diagnosis of myocardial ischemia during ERCP

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