A prospective assessment of sedation-related adverse events and patient and endoscopist satisfaction in ERCP with anesthesiologist-administered sedation - 11/08/11
Reprint requests: Mandeep S. Sawhney, MD, Division of Gastroenterology, Rabb Rose 101, Beth Israel Deaconess Medical Center East, 330 Brookline Avenue, Boston, MA 02215Résumé |
Background |
Despite the increasing use of anesthesiologist-administered sedation for monitored anesthesia care (MAC) or general anesthesia in patients undergoing ERCP, limited prospective data exist on the effectiveness, safety, and cost of this approach.
Objective |
To prospectively assess sedation-related adverse events (SRAEs), patient- and procedure-related risk factors associated with SRAEs, and endoscopist and patient satisfaction with anesthesiologist-administered sedation.
Design |
Single-center, prospective cohort study.
Setting |
Tertiary-care referral center.
Patients |
A total of 528 consecutive patients undergoing ERCP.
Interventions |
Anesthesiologist-administered MAC or general anesthesia.
Main Outcome Measurements |
SRAEs, endoscopist and patient satisfaction.
Results |
There were 120 intraprocedure SRAEs during 109 of the 528 ERCPs (21% of cases). Intraprocedure SRAEs included hypotension (38 events), arrhythmia (20 events), O2 desaturation to less than 85% (66 events), unplanned intubation (16 events), and procedure termination (1 event). Thirty postprocedure SRAEs occurred in a total of 22 patients (4% of cases), including hypotension (5 events), endotracheal intubation (2 events), and arrhythmia (12 events). Patient-related variables associated with adverse intraprocedure events were American Society of Anesthesiologists class (P = .004) and body mass index (kg/m2) (P = .02). On a 10-point scale, mean endoscopist satisfaction with sedation was 9.2 (standard deviation 1.8) and patient satisfaction with sedation was 9.9 (standard deviation 0.7).
Limitations |
The approach to sedation was not randomized.
Conclusions |
Higher American Society of Anesthesiologists class and body mass index are associated with an increased rate of cardiac and respiratory events during ERCP. Cardiac and respiratory events are generally minor, and MAC can be considered a safe option for most ERCP patients. Despite the frequency of minor sedation-related events, procedure interruption or premature termination was rare in the setting of anesthesiologist-administered sedation.
Le texte complet de cet article est disponible en PDF.Abbreviations : ASA, BMI, COPD, GA, HR, MAC, OR, SRAE, VAS
Plan
| DISCLOSURE: All authors disclosed no financial relationships relevant to this publication. |
Vol 73 - N° 4
P. 710-717 - avril 2011 Retour au numéro
Article précédent
- Making sense of meta-analyses on the use of protease inhibitors for the prevention of post-ERCP pancreatitis
- Todd H. Baron, Takao Itoi
- Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter U.S. series
- Timothy B. Gardner, Nayantara Coelho-Prabhu, Stuart R. Gordon, Andres Gelrud, John T. Maple, Georgios I. Papachristou, Martin L. Freeman, Mark D. Topazian, Rajeev Attam, Todd A. Mackenzie, Todd H. Baron
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?