Different Anesthetic Technique For ERCP

Deep Sedation and General Anesthesia for Endoscopic Retrograde Cholangiopancreatography

Providing the appropriate anesthetic technique for endoscopic retrograde cholangiopancreatography (ERCP) in remote locations can be challenging. The aim of this study was therefore to prospectively assess and compare the feasibility of monitored anesthesia care (MAC) with propofol based deep sedation, standard general anesthesia and general anesthesia without neuromuscular blockade in patients undergoing ERCP.

ERCP is identified as one of the most invasive endoscopic procedures, during which patients may experience anxiety, discomfort and suffer different degree of pain. So, anesthesia and analgesia are essential for this invasive procedure, especially therapeutic ERCPs. Thus, we compared the efficacy of using monitored anesthesia care (MAC) with deep sedation versus general anesthesia (GA) to perform this procedure and the incidence of complications associated with these methods of anesthesia.

Previous studies have concluded that intubation is possible without the use of neuromuscular blockade. We assume that the use of propofol and adjuvants short-acting opioids may provide adequate conditions for tracheal intubation. It was also hypothesized that it may also be useful in facilitating ERCP under general anesthesia without neuromuscular blockade.

Inclusion Criteria:

• Aged 18-70 years old
• Grade Ⅰ and Ⅲ according to physical status classification system of the American Society of Anesthesiologists (ASA)
• Coagulation function tests in normal range

Exclusion Criteria:

• Potentially difficult airways
• Administration of sedative or narcotic drugs in the previous 24 hours
• Severe renal or hepatic impairment
• Severe cardiopulmonary comorbidities (defined as American Society of Anesthesiologists physical status IV or greater)
• Contraindications to a nasotracheal intubation
• Coagulopathy
• History of frequent episodes of epistaxis
• Emergent ERCP
• At risk for reflux and aspiration