Faculty Collaboration Database

Anesthesia-administered sedation for endoscopic retrograde cholangiopancreatography: monitored anesthesia care or general endotracheal anesthesia? Curr Opin Anaesthesiol 2019 Aug;32(4):531-537

Date

04/18/2019

Pubmed ID

30994476

DOI

10.1097/ACO.0000000000000741

Scopus ID

2-s2.0-85069235441 (requires institutional sign-in at Scopus site)   16 Citations

Abstract

PURPOSE OF REVIEW: The decision to undertake monitored anesthesia care (MAC) or general endotracheal anesthesia (GEA) for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is influenced by many factors. These include locoregional practice preferences, procedure complexity, patient position, and comorbidities. We aim to review the data regarding anesthesia-administered sedation for ERCP and identify the impact of airway management on procedure success, adverse event rates and endoscopy unit efficiency.

RECENT FINDINGS: Several studies have consistently identified patients at high risk for sedation-related adverse events during ERCP. This group includes those with higher American Society of Anesthesiologists class and (BMI). ERCP is commonly performed in the prone position, which can make the placement of an emergent advanced airway challenging. Although this may be alleviated by performing ERCP in the supine position, this technique is more technically cumbersome for the endoscopist. Data regarding the impact of routine GEA on endoscopy unit efficiency remain controversial.

SUMMARY: Pursuing MAC or GEA for patients undergoing ERCP is best-approached on an individual basis. Patients at high risk for sedation-related adverse events likely benefit from GEA. Larger, multicenter randomized controlled trials will aid significantly in better delineating which sedation approach is best for an individual patient.

Author List

Smith ZL, Das KK, Kushnir VM

Author

Zachary Smith DO Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anesthesia, Endotracheal
Anesthesia, General
Cholangiopancreatography, Endoscopic Retrograde
Clinical Decision-Making
Conscious Sedation
Female
Humans
Hypnotics and Sedatives
Male
Monitoring, Intraoperative
Pain, Procedural
Patient Positioning
Patient Satisfaction
Patient Selection
Propofol