Randomized trial comparing general anesthesia with anesthesiologist-administered deep sedation for ERCP in average-risk patients

Alzanbagi, Adnan Baraka; Jilani, Tariq Lufti; Qureshi, Laeeque Ahmed; Ibrahim, Ibrahim Mohamed; Tashkandi, Abdulaziz Mohammed Saeed; Elshrief, Eman Elsayed Ali; Khan, Mohammed S.; Abdelhalim, Manal Ali Hafez; Zahrani, Saad Ahmed; Mohamed, Wafaa Mohamed Kamel; Nageeb, Ahmed Mohammed; Abbushi, Belal; Shariff, Kareem

doi:10.1016/j.gie.2022.06.003

Cited by 9 publications

(2 citation statements)

References 21 publications

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“…We, however, prefer deep sedation due to several advantages: it does not require an anesthesiologist, offering procedural flexibility; it often results in shorter procedure times due to faster sedation induction leading to more efficient use of operation room resources. This approach aligns with findings from percutaneous mitral valve repair and ERCP studies, which showed that general anesthesia led to longer procedure and sedation induction times without significantly improving patient satisfaction, compared to deep sedation [25,26].…”

Section: Sedation Conceptsupporting

confidence: 72%

Focal Pulsed Field Ablation for Atrial Arrhythmias: Efficacy and Safety under Deep Sedation

Weyand,

Adam,

Biehler

et al. 2024

JCM

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Focal pulsed field ablation (PFA) is a novel technique for treating cardiac arrhythmias. It has demonstrated positive results in initial studies and has a good safety profile. In recent studies, PFA was often utilized for first-time pulmonary vein isolation (PVI) and was performed under general anesthesia. In our study, we assessed the feasibility, safety, acute procedural efficacy, and efficiency of focal PFA under deep sedation in patients, 80% of whom had undergone at least one left atrial ablation previously. We treated 30 patients (71 ± 7, 46% male) using the CENTAURI system for various atrial arrhythmias, including atrial fibrillation, typical and atypical atrial flutter, and focal atrial tachycardia. The average procedure and fluoroscopy times were 122 ± 43 min and 9 ± 7 min, respectively. A total of 83.33% of patients received additional line ablations beyond PVI, specifically targeting the posterior box and anterior mitral line. All ablations were successfully performed in deep sedation with only one major and one minor complication observed. The major complication was a vasospasm of the right coronary artery during ablation of the cavotricuspid isthmus, which was treated successfully with intracoronary nitroglycerin. All patients could be discharged in sinus rhythm. Moreover, adenosine appears effective in identifying dormant conduction in some patients after focal PFA. In conclusion, focal PFA is an effective approach for complex left atrial ablations under deep sedation, offering both high efficacy and efficiency with a reliable safety profile. Studies on long-term outcomes are needed.

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Section: Sedation Conceptsupporting

confidence: 72%

Focal Pulsed Field Ablation for Atrial Arrhythmias: Efficacy and Safety under Deep Sedation

Weyand,

Adam,

Biehler

et al. 2024

JCM

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“…ERCP is mainly used for the diagnosis and treatment of biliary and pancreatic diseases. The most commonly used anesthesia methods of ERCP are endotracheal intubation general anesthesia (GA) and deep sedation anesthesia(DSA) [1][2][3] . During the operation, the patient's side prone or prone position causes chest and abdomen compression, which has a signi cant impact on respiration and circulation [4,5] .Research shows that [6,7] , Although GA group can provide good airway protection during operation, the incidence of hypotension, acute respiratory failure and pneumonia is higher than that of non GA group.…”

Section: Introductionmentioning

confidence: 99%

Comparison of anesthetic effects of different doses of alfentanil combined with ciprofol in elderly patients undergoing ERCP :a randomized controlled trial

Zhu

et al. 2023

Preprint

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Background and Objects: Patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) are often old and poor in physical fitness. The purpose of this study was to investigate the anesthetic effect of different doses of alfentanil combined with ciprofol in elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods: In this clinical trial, 137 patients, who were candidates for ERCP were randomly divided into three groups. Group A were given 0.15 µg/kg/min of alfentanil in maintenance stage, Group B were given 0.25 µg/kg/min and Group C were given 0.35 µg/kg/min. Mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2) of the patients at each time point including the entry into the operation room (T0), at the beginning of surgery(T1), 10 minutes after surgery(T2), 20 minutes after surgery(T3), 30 minutes after surgery(T4),endoscopy withdrawal (T5) were recorded. Adverse events(including respiratory depression, body movement and hypoxemia),the dosage of ciprofen, the time of operation time and awakening were recorded. Results: Compared with Group A, MAP and HR in Group B and Group C was decreased during T1-T5 (P < 0.05). Compared with group B, MAP and HR in group C was decreased during T1-T5 (P < 0.05). Compared with Group A and Group C ,the number of adverse reactions of Group B was decreased(P < 0.05). There was no statistical difference in surgical time among the three groups(P>0.05) ,but t a statistically significant difference in recovery time (P < 0.05). Conclusion: The adverse events of alfentanil 0.25µg/kg/min combined with ciprofol were low, and the anesthetic effect was the best.

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Consensus guidelines for the perioperative management of patients undergoing endoscopic retrograde cholangiopancreatography

Azimaraghi¹,

Bilal²,

Amornyotin³

et al. 2023

British Journal of Anaesthesia

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Randomized trial comparing general anesthesia with anesthesiologist-administered deep sedation for ERCP in average-risk patients

Cited by 9 publications

References 21 publications

Focal Pulsed Field Ablation for Atrial Arrhythmias: Efficacy and Safety under Deep Sedation

Focal Pulsed Field Ablation for Atrial Arrhythmias: Efficacy and Safety under Deep Sedation

Comparison of anesthetic effects of different doses of alfentanil combined with ciprofol in elderly patients undergoing ERCP :a randomized controlled trial

Consensus guidelines for the perioperative management of patients undergoing endoscopic retrograde cholangiopancreatography

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