TY - JOUR
T1 - Anesthesia-administered sedation for endoscopic retrograde cholangiopancreatography
T2 - Monitored anesthesia care or general endotracheal anesthesia?
AU - Smith, Zachary L.
AU - Das, Koushik K.
AU - Kushnir, Vladimir M.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Purpose of reviewThe 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 findingsSeveral 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.SummaryPursuing 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.
AB - Purpose of reviewThe 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 findingsSeveral 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.SummaryPursuing 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.
KW - ERCP
KW - anesthesia
KW - endoscopy
KW - endotracheal
KW - prone position
UR - http://www.scopus.com/inward/record.url?scp=85069235441&partnerID=8YFLogxK
U2 - 10.1097/ACO.0000000000000741
DO - 10.1097/ACO.0000000000000741
M3 - Review article
C2 - 30994476
AN - SCOPUS:85069235441
SN - 0952-7907
VL - 32
SP - 531
EP - 537
JO - Current Opinion in Anaesthesiology
JF - Current Opinion in Anaesthesiology
IS - 4
ER -