Outpatient endoscopic retrograde cholangiopancreatography: Safety and efficacy of anesthetic management with a natural airway in 653 consecutive procedures

Abstract

Background:Endoscopic retrograde cholangiopancreatography (ERCP) is a unique diagnostic and therapeutic procedure performed in high risk patients in prone/semi-prone position. Propofol based deep sedation has emerged as the method of choice however, the ability to predict possible complications is yet un-explored.Aims:The present study aimed to evaluate known high risk-factors for general anesthesia (American Society of Anesthesiologists (ASA) status, body mass index (BMI), and Mallampati class) for their ability to affect outcomes in ERCP patients.Study Design:Retrospective data of 653 patients who underwent ERCP during a period of 26 months at university hospital of Pennsylvania was reviewed. Patient-specific and procedure specific data was extracted. Desaturation was defined by fall of pulse oximeter saturation below 95% and its relation to patient specific high risk-factors was analyzed.Results:Only 45 patients had transient de-saturation below 95% without any residual sequlae. No statistically significant relation between desaturation episodes and patients higher ASA status or BMI or modified Mallampati (MMP) class was found. Despite 60% patients being ASA III/IV none required emergency intubation or procedural interruption. Optimal oxygenation and airway patency was maintained with high degree of success using simple airway maneuvers or conduit devices (nasal/oral trumpet) with oxygen supplementation in all patients.Conclusions:Unlike general anesthesia, pre-operative patient ASA status, higher MMP or increasing BMI does not bear relation with likelihood of patients desaturating during ERCP. In presence of vigilant apnea monitoring and careful dose titration of maintenance anesthetics with airway conduits, general anesthesia, emergency intubations, and procedure interruptions can be avoided.

Anesthesia for gastrointestinal endoscopy in patients with left ventricular assist devices: Initial experience with 68 procedures

“…Airway complications like obstruction and apnea under deep sedation are known to be primarily dependent upon the depth of anesthesia rather than patient physical status alone. [18,19] As all our patients were in lateral position, the chances of upper airway obstruction due to tongue fall were less; in case of transient desaturation, most patients responded to increased oxygen supplementation in addition to dose readjustments, with saturations returning to baseline. In patients with LVAD, if oxygen saturation does not respond to the above measures, a possibility of right ventricular dysfunction must be considered.…”

Therapeutic Endoscopy Can Be Performed Safely in an Ambulatory Surgical Center: A Multicenter, Prospective Study

“…This sentiment was examined by Coté et al demonstrating significant risk for ASA scoring ≥3 predicting the need for airway maneuvers during advanced endoscopic procedures [33]. Other retrospective analyses have evaluated ASA scoring as a risk for serious AE in the setting of therapeutic endoscopy [34, 35]. As a result, most prior studies evaluating ASC therapeutic endoscopy either included a minimal number of individuals with ASA classes ≥III or excluded them entirely [3–18].…”

Photoplethysmography respiratory rate monitoring in patients receiving procedural sedation and analgesia for upper gastrointestinal endoscopy

“…Age, male sex, comorbidities, fentanyl use, ASA classification, and BMI were previously reported as independent risk factors for respiratory events during UGI endoscopy [1, 2, 16, 17]. In contrast, Goudra et al [18] found no increased risk for hypoxaemia in patients with a higher ASA classification or BMI when patients were pre-oxygenated with 100 % oxygen prior to drug administration and received an airway device to maintain a patent airway. Our study shows that a hypoxaemic episode was preceded by apnoea in only in 34 % of the cases, with a delay of about 40 s between apnoea and the development of hypoxaemia.…”