Complications of Anesthesia Services in Gastrointestinal Endoscopic Procedures

Lieber, Sarah R.; Heller, Benjamin J.; Martin, Christopher F.; Howard, Christopher W.; Crockett, Seth D.

doi:10.1016/j.cgh.2019.10.011

Cited by 22 publications

(19 citation statements)

References 17 publications

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“…Similarly, using the same NACOR database, we calculated an overall frequency of serious complications to be 0.34% for the general population. ( 24 ) Our slightly higher estimate of 0.38% serious complications (primarily among upper endoscopies) may indeed reflect an increased risk of complication in cirrhosis that can be explained by disease complexity, including coagulopathy, as well as tenuous fluid and mental status changes.…”

Section: Discussionmentioning

confidence: 83%

“…Overall, serious complications were uncommon (0.38%), but were higher than those calculated for the general population (0.34%). ( 24 ) A majority of serious complications were cardiovascular in nature. Serious complications were significantly associated with higher ASA and general anesthesia, suggesting that complexity and severity of disease may drive the risk of complication.…”

Section: Discussionmentioning

confidence: 99%

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Complications Associated With Anesthesia Services in Endoscopic Procedures Among Patients With Cirrhosis

et al. 2020

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BaCKgRoUND aND aIMS: Anesthesia services for endoscopic procedures have proliferated with the promise of increased comfort and safety. Cirrhosis patients are higher risk for sedation, yet limited data are available describing anesthesia complications in this population. appRoaCH aND ReSUltS: This cross-sectional study utilized the National Anesthesia Clinical Outcomes Registry, a multicenter quality-improvement database from 2010 to 2015. Patients with cirrhosis undergoing an endoscopy were identified by International Classification of Diseases, Ninth Revision (ICD-9)/Current Procedures Terminology (CPT) codes. The outcome of interest was serious anesthesia-related complication defined as cardiovascular, respiratory, neurological, drug related, patient injury, death, or unexpected admission. A mixed-effects multivariate logistic regression model determined odds ratios (ORs) between variables and serious complications, adjusting for potential confounders. In total, 9,007 endoscopic procedures were performed among patients with cirrhosis; 92% were esophagogastroduodenoscopies. The majority (81%) were American Society of Anesthesiologists (ASA) class ≥3, and 72% had a history of hepatic encephalopathy, ascites, varices, hepatorenal syndrome, or spontaneous bacterial peritonitis identified by ICD-9/CPT codes. In total, 87 complications were reported, 33 of which were serious. Frequency

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Complications Associated With Anesthesia Services in Endoscopic Procedures Among Patients With Cirrhosis

et al. 2020

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“…Prior to Propofol use and general anesthesia, intolerance of sedation with discomfort was noted in one third to one half of ERCPs[ 16 ]. Comorbid patients with higher American Society of Anesthesiologist scores are more likely to have anesthesiologist involvement[ 17 ]. The safety of anesthesia service in endoscopy was analysed in a large cross-sectional study using the National Anesthesia Clinical Outcomes Registry.…”

Section: Infection Prevention and Quality Improvementmentioning

confidence: 99%

“…The safety of anesthesia service in endoscopy was analysed in a large cross-sectional study using the National Anesthesia Clinical Outcomes Registry. A total of 27721 patients had an ERCP performed with 12 deaths and 1052 anesthesia-related complications reported[ 17 ]. In the unadjusted model, ERCP was associated with an elevated odds ratio (OR) of 8.83 [95% confidence interval (CI): 7.70-10.12] relative to colonoscopy, that was not significant in the multivariate analysis.…”

Section: Infection Prevention and Quality Improvementmentioning

confidence: 99%

Endoscopic retrograde cholangiopancreatography: Current practice and future research

Sanders¹,

Bomman²,

Krishnamoorthi³

et al. 2021

WJGE

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Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from a primarily diagnostic to therapeutic procedure in hepatobiliary and pancreatic disease. Most commonly, ERCPs are performed for choledocholithiasis with or without cholangitis, but improvements in technology and technique have allowed for management of pancreatic duct stones, benign and malignant strictures, and bile and pancreatic leaks. As an example of necessity driving innovation, the new disposable duodenoscopes have been introduced into practice. With the advantage of eliminating transmissible infections, they represent a paradigm shift in quality improvement within ERCP. With procedures becoming more complicated, the necessity for anesthesia involvement and safety of propofol use and general anesthesia has become better defined. The improvements in endoscopic ultrasound (EUS) have allowed for direct bile duct access and EUS facilitated bile duct access for ERCP. In patients with surgically altered anatomy, selective cannulation can be performed with overtube-assisted enteroscopy, laparoscopic surgery assistance, or the EUS-directed transgastric ERCP. Cholangioscopy and pancreatoscopy use has become ubiquitous with defined indications for large bile duct stones, indeterminate strictures, and hepatobiliary and pancreatic neoplasia. This review summarizes the recent advances in infection prevention, quality improvement, pancreaticobiliary access, and management of hepatobiliary and pancreatic diseases. Where appropriate, future research directions are included in each section.

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“…Nonetheless, the facility should maintain a careful selection process for appropriate patients to be performed in these outpatient facilities. Poor patient or procedure selection can result in unwanted admission to an affiliated hospital 26 , 27 .…”

Section: Introductionmentioning

confidence: 99%

Pushing the Envelope

Young

Pollard

Shapiro

2021

Advances in Anesthesia

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Synopsis In 2018, over 23 million ambulatory surgeries were performed in the US, representing the continued trajectory of procedures moving from hospitals towards ambulatory facilities. The primary incentives are improved costs, convenience, and patient satisfaction. Careful evaluation of patients, procedures, costs, and outcomes is required to be successful. Due to the COVID-19 pandemic, surgeons and anesthesiologists must now pay attention to local, state, and federal guidelines developed to manage COVID-19: screening, testing, and PPE. A few positives have resulted from COVID-19: improved and more consistent facility hygiene, consistent mask usage, and social distancing. The rise of telemedicine in pre-anesthesia screening has facilitated Case flow, reducing same-day surgery cancellations while saving the everyone time and money.

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Complications of Anesthesia Services in Gastrointestinal Endoscopic Procedures

Cited by 22 publications

References 17 publications

Complications Associated With Anesthesia Services in Endoscopic Procedures Among Patients With Cirrhosis

Complications Associated With Anesthesia Services in Endoscopic Procedures Among Patients With Cirrhosis

Endoscopic retrograde cholangiopancreatography: Current practice and future research

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