Outcomes after endoscopic retrograde cholangiopancreatography with general anaesthesia versus sedation

Althoff, Friederike C.; Agnihotri, Abhishek; Grabitz, Stephanie D.; Santer, Peter; Nabel, Sarah; Tran, Tuyet; Berzin, Tyler M.; Sundar, Eswar; Xu, Xinling; Sawhney, Mandeep S.; Eikermann, Matthias

doi:10.1016/j.bja.2020.08.057

Cited by 24 publications

(19 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, to account for unmeasured confounding that may have biased results obtained from a standard logistic regression model, we used an instrumental variable analysis. 13 Considering a downward trend of tracheal tube vs SGA use during the more recent years, we tested whether year of surgery would be a valid instrumental variable. An instrumental variable analysis can be used in situations where the instrument (year of surgery) is associated with the exposure (choice of airway device, tracheal tube vs SGA), whereas it is not associated with the clinical outcome (reintubation) except through its effect on the exposure.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

Supraglottic airway device versus tracheal intubation and the risk of emergent postoperative intubation after general anaesthesia in adults: a retrospective cohort study

Hammer

Santer

Schaefer

et al. 2021

British Journal of Anaesthesia

Self Cite

View full text Add to dashboard Cite

Section: Sensitivity Analysesmentioning

confidence: 99%

Supraglottic airway device versus tracheal intubation and the risk of emergent postoperative intubation after general anaesthesia in adults: a retrospective cohort study

Hammer

Santer

Schaefer

et al. 2021

British Journal of Anaesthesia

Self Cite

View full text Add to dashboard Cite

“…ERCP is an essential diagnostic and therapeutic method for biliary and pancreatic diseases, generally conducted under anesthesia due to its painful and time-consuming properties. Sedation without intubation administered by an anesthesiologist appears to be the most recommended strategy for ERCP due to a reduced incidence of adverse discharge [15]. Propofol is the mainstay sedative for sedation without intubation during gastrointestinal endoscopy for its outstanding characters of potent action, rapid onset, and fast recovery [16].…”

Section: Discussionmentioning

confidence: 99%

Comparison of sedation efficacy and safety between dexmedetomidine and propofol during endoscopic retrograde cholangiopancreatography: A prospective, randomized, single-blinded trial

Zhang

Wang

Zhu

et al. 2022

Preprint

View full text Add to dashboard Cite

BackgroundPropofol-balanced sedation is widely used in endoscopic retrograde cholangiopancreatography (ERCP) procedures, but sedation-related adverse events (SRAEs) commonly occur. The combination of dexmedetomidine with opioids and benzodiazepines has provided effective sedation with a superlative degree of safety during different clinical scenarios. The aim of this study was to compare sedation e cacy and safety between dexmedetomidine and propofol with a balanced administration of opioids and benzodiazepines during ERCP procedures. MethodsForty-one patients were randomly divided into two groups, the dexmedetomidine (DEX) group and the propofol (PRO) group. As premedication, all participants received an intravenous bolus dose of 0.02 mg•kg − 1 midazolam and 0.2 µg•kg − 1 sufentanil. Patients in the DEX group received an additional bolus of 0.6 µg•kg − 1 dexmedetomidine over 2 min followed by a dexmedetomidine infusion at 1.2 µg•kg − 1 •h − 1 , whereas the PRO group received a 1-2 mg•kg − 1 propofol bolus over 30 s followed by a propofol infusion at 2-3 mg•kg − 1 •h − 1 . The primary outcome was the incidence of hypoxemia (SpO 2 < 90% for > 10 s) during ERCP. ResultsAll patients achieved the targeted sedation level with the Ramsay Sedation Scale ≥ 4. When compared with the PRO group, the incidence of hypoxemia was signi cantly reduced in the DEX group. Respiratory depression (respiratory rate of < 10 bpm•min − 1 ) was more frequently observed among PRO patients than DEX patients. During procedures, endoscopists' and patients' satisfaction scores were comparable between groups, as were patients' pain and amnesia scores. ConclusionsDexmedetomidine provided satisfactory sedation safety with no downstream effects on sedation e cacy when performing ERCP in comparison with propofol in combination with opioids and benzodiazepines.

show abstract

“…The depth of anesthesia required during GEA increases the risk of hypotension, which can subsequently lead to an increased risk of myocardial injury, renal injury, and possibly death. 26 Because ERCP is performed in the prone or semiprone position, multiple people are required to safely position and secure the patient while turning from supine to prone position on the fluoroscopy table. There is always a risk of endotracheal tube displacement or accidental extubation during positioning.…”

Section: Pro: Anesthesia For Ercp Is Best Done With Macmentioning

confidence: 99%

Pro-Con Debate: Monitored Anesthesia Care Versus General Endotracheal Anesthesia for Endoscopic Retrograde Cholangiopancreatography

Janik

Stamper

Vender

et al. 2022

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

Over the past several decades, anesthesia has experienced a significant growth in nonoperating room anesthesia. Gastrointestinal suites represent the largest volume location for off-site anesthesia procedures, which include complex endoscopy procedures like endoscopic retrograde cholangiopancreatography (ERCP). These challenging patients and procedures necessitate a shared airway and are typically performed in the prone or semiprone position on a dedicated procedural table. In this Pro-Con commentary article, the Pro side supports the use of monitored anesthesia care (MAC), citing fewer hemodynamic perturbations, decreased side effects from inhalational agents, faster cognitive recovery, and quicker procedural times leading to improved center efficiency (ie, quicker time to discharge). Meanwhile, the Con side favors general endotracheal anesthesia (GEA) to reduce the infrequent, but well-recognized, critical events due to impaired oxygenation and/or ventilation known to occur during MAC in this setting. They also argue that procedural interruptions are more frequent during MAC as anesthesia professionals need to rescue patients from apnea with various airway maneuvers. Thus, the risk of hypoxemic episodes is minimized using GEA for ERCP . Unfortunately, neither position is supported by large randomized controlled trials. The consensus opinion of the authors is that anesthesia for ERCP should be provided by a qualified anesthesia professional who weighs the risks and benefits of each technique for a given patient and clinical circumstance. This Pro-Con article highlights the many challenges anesthesia professionals face during ERCPs and encourages thoughtful, individualized anesthetic plans over knee-jerk decisions. Both sides agree that an anesthetic technique administered by a qualified anesthesia professional is favored over an endoscopist-directed sedation approach.

show abstract

Outcomes after endoscopic retrograde cholangiopancreatography with general anaesthesia versus sedation

Cited by 24 publications

References 29 publications

Supraglottic airway device versus tracheal intubation and the risk of emergent postoperative intubation after general anaesthesia in adults: a retrospective cohort study

Supraglottic airway device versus tracheal intubation and the risk of emergent postoperative intubation after general anaesthesia in adults: a retrospective cohort study

Comparison of sedation efficacy and safety between dexmedetomidine and propofol during endoscopic retrograde cholangiopancreatography: A prospective, randomized, single-blinded trial

Pro-Con Debate: Monitored Anesthesia Care Versus General Endotracheal Anesthesia for Endoscopic Retrograde Cholangiopancreatography

Contact Info

Product

Resources

About