A prospective assessment of sedation-related adverse events and patient and endoscopist satisfaction in ERCP with anesthesiologist-administered sedation

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-re...

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Published in:Gastrointestinal endoscopy 2011-04, Vol.73 (4), p.710-717
Main Authors: Berzin, Tyler M., MD, Sanaka, Sirish, MD, Barnett, Sheila R., MD, Sundar, Eswar, MD, Sepe, Paul S., MD, Jakubowski, Moshe, PhD, Pleskow, Douglas K., MD, Chuttani, Ram, MD, Sawhney, Mandeep S., MD
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Anesthesia
Anesthesia Recovery Period
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Anesthetics, Intravenous - administration & dosage
Anesthetics, Intravenous - adverse effects
Arrhythmias, Cardiac - epidemiology
Arrhythmias, Cardiac - etiology
Biological and medical sciences
Cholangiopancreatography, Endoscopic Retrograde
Conscious Sedation - adverse effects
Digestive system
Female
Follow-Up Studies
Gastroenterology and Hepatology
Gastroenterology. Liver. Pancreas. Abdomen
General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation
Humans
Hypertension - epidemiology
Hypertension - etiology
Incidence
Investigative techniques, diagnostic techniques (general aspects)
Male
Medical sciences
Middle Aged
Patient Satisfaction
Propofol - administration & dosage
Propofol - adverse effects
Prospective Studies
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Risk Assessment - methods
Young Adult
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Summary: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.
ISSN:0016-5107
1097-6779
DOI:10.1016/j.gie.2010.12.011