A randomized controlled trial evaluating general endotracheal anesthesia versus monitored anesthesia care and the incidence of sedation-related adverse events during ERCP in high-risk patients

Gastrointestinal Endoscopy
Zachary L SmithVladimir M Kushnir

Abstract

ERCP is a complex procedure often performed in patients at high risk for sedation-related adverse events (SRAEs). However, there is no current standard of care with regard to mode of sedation and airway management during ERCP. The aim of this study was to assess the safety of general endotracheal anesthesia (GEA) versus propofol-based monitored anesthesia care (MAC) without endotracheal intubation in patients undergoing ERCP at high risk for SRAEs. Consecutive patients undergoing ERCP at high risk for SRAEs at a single center were invited to participate in this randomized controlled trial comparing GEA and MAC. Inclusion criteria were STOP-BANG score ≥3, abdominal ascites, body mass index ≥35, chronic lung disease, American Society of Anesthesiologists class >3, Mallampati class 4 airway, and moderate to heavy alcohol use. Exclusion criteria were preceding EUS, emergent ERCP, tracheostomy, unstable airway, gastric outlet obstruction or delayed gastric emptying, and altered foregut anatomy. The primary endpoint was composite incidence of SRAEs: hypoxemia, use of airway maneuvers, hypotension requiring vasopressors, sedation-related procedure interruption, cardiac arrhythmia, and respiratory failure. Secondary outcomes included p...Continue Reading

Associated Clinical Trials

Citations

Nov 23, 2019·Anesthesiology and Pain Medicine·Ahmad HormatiHamed Shafiee
Sep 19, 2019·Scandinavian Journal of Gastroenterology·Liv Bjerre Juul NielsenLars Tue Sørensen
Jul 10, 2020·Digestive Diseases and Sciences·Tilak Shah, Stefan Ianchulev
Oct 21, 2020·Anesthesia and Analgesia·Katherine B HaganCarin A Hagberg
Oct 31, 2020·Digestive Endoscopy : Official Journal of the Japan Gastroenterological Endoscopy Society·Takuji GotodaHaruhiro Inoue
Oct 14, 2020·British Journal of Anaesthesia·Friederike C AlthoffMatthias Eikermann
Dec 3, 2021·Geriatrics & Gerontology International·Nong HeFu-Shan Xue

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