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Hagan KB, Coronel E, Ge P, Hagberg C. A randomized controlled trial of the LMA® Gastro™ compared to nasal cannula for endoscopic retrograde cholangiopancreatography. Anaesth Crit Care Pain Med 2024; 43:101379. [PMID: 38508391 DOI: 10.1016/j.accpm.2024.101379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Katherine B Hagan
- The University of Texas MD Anderson Cancer Center - Houston, Department of Anesthesiology and Perioperative Medicine, 1400 Holcombe Blvd, Houston, 77030 TX, United States.
| | - Emmanuel Coronel
- The University of Texas MD Anderson Cancer Center - Houston, Department of Gastroenterology, Hepatology, and Nutrition, 1400 Holcombe Blvd, Houston, 77030 TX, United States
| | - Phillip Ge
- The University of Texas MD Anderson Cancer Center - Houston, Department of Gastroenterology, Hepatology, and Nutrition, 1400 Holcombe Blvd, Houston, 77030 TX, United States
| | - Carin Hagberg
- The University of Texas MD Anderson Cancer Center - Houston, Department of Anesthesiology and Perioperative Medicine, 1400 Holcombe Blvd, Houston, 77030 TX, United States
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2
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Goudra B. Setting Up an Ambulatory GI Endoscopy Suite in the USA-Anesthesia and Sedation Challenges. J Clin Med 2024; 13:4335. [PMID: 39124602 PMCID: PMC11313587 DOI: 10.3390/jcm13154335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/19/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
Gastrointestinal endoscopy units, both freestanding and associated with ambulatory surgical centers, are on the increase, and the trend is likely to continue. The concept is relatively new, and there are insufficient guidelines and a general dearth of information for prospective planners and physicians. Debate continues in areas such as the selection of patients, appropriateness of procedures, and access to tertiary care. Leaders often scramble to address both critical and non-critical issues, often after the center has opened to the public. They often encounter issues which were not anticipated. In this review, we have provided comprehensive and concise information on the various aspects of starting and running an endoscopy unit. Some of the areas considered are referral and recruitment systems, determination of the need and site selection, layout and regulations, aspects related to drugs, equipment, medical emergencies, and emergency room transfers, discharge criteria, post-discharge follow-up, and finally, we have addressed issues related to avoiding and managing cancelations. It is assumed that a majority of the procedures are performed with predominantly propofol-induced deep sedation.
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Affiliation(s)
- Basavana Goudra
- Jefferson Surgical Center Endoscopy, Department of Anesthesiology, Sidney Kimmel Medical College, Jefferson Health, 111 S 11th Street, #8280, Philadelphia, PA 19107, USA
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3
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Xiang JH, Wei P, Zhang YJ, Li LL, Li X, Wang J, Xie J, Zhong Y, Gao H, Yuan L, Chen WT, Song JG. Safety of prone emergence from general endotracheal anesthesia in patients undergoing ERCP: a randomized controlled trial. Surg Endosc 2023; 37:7493-7501. [PMID: 37415015 DOI: 10.1007/s00464-023-10187-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/30/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Conventional supine emergence and prone extubation from general endotracheal anesthesia (GEA) are associated with extubation-related adverse events (ERAEs). Given the minimally invasive nature of endoscopic retrograde cholangiopancreatography (ERCP) as well as the improved ventilation/perfusion matching and easier airway opening in the prone position, we aimed to assess the safety of prone emergence and extubation in patients undergoing ERCP under GEA. METHODS Totally, 242 eligible patients were recruited and randomized into the supine extubation group (n = 121; supine group) and the prone extubation group (n = 121; prone group). The primary endpoint was the incidence of ERAEs during emergence, including hemodynamic fluctuations, coughing, stridor, and hypoxemia requiring airway maneuvers. The secondary endpoints included the incidence of monitoring disconnections, extubation time, recovery time, room exit time, and post-procedure sore throat. RESULTS The incidence of ERAEs was significantly lower in the prone group compared with the supine group (8.3% vs 34.7%, OR = 0.17, 95% CI 0.18-0.56; P < 0.001). Moreover, the prone group demonstrated no monitoring disconnections, shorter extubation time and room exit time, faster recovery, and, lower frequency and milder sore throat after the procedure. CONCLUSIONS For patients undergoing ERCP under GEA, compared with supine, prone emergence, and extubation had remarkably lower rates of EAREs and better recovery, and can maintain continuous monitoring and improve efficiency.
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Affiliation(s)
- Jin-Hui Xiang
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Pan Wei
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Yu-Jiao Zhang
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Li-Li Li
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Xing Li
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Jian Wang
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Jian Xie
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Yong Zhong
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Hao Gao
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Lan Yuan
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Shanghai, 201203, China
| | - Wen-Ting Chen
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Shanghai, 201203, China.
- Acupuncture and Anesthesia Research Institute, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Jian-Gang Song
- Department of Anesthesiology, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, No. 528 Zhangheng Road, Shanghai, 201203, China.
- Acupuncture and Anesthesia Research Institute, Shuguang Hospital Affiliated with Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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4
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Barakat MT, Angelotti T, Ghosh S, Banerjee S. Prospective randomized comparison of endoscopist-facilitated endotracheal intubation and standard intubation for ERCP. Gastrointest Endosc 2023; 98:441-447. [PMID: 36878302 DOI: 10.1016/j.gie.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 02/16/2023] [Accepted: 02/26/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND AND AIMS Complex endoscopic procedures are increasingly performed with anesthesia support, which substantially affects endoscopy unit efficiency. ERCP performed with the patient under general anesthesia presents unique challenges, as patients are typically first intubated, then transferred to the fluoroscopy table and positioned semi-prone. This requires additional time and staff while increasing the potential for patient/staff injury. We have developed the technique of endoscopist-facilitated intubation using an endotracheal tube backloaded onto an ultra-slim gastroscope as a potential solution to these issues and evaluated its utility prospectively. METHODS Sequential patients undergoing ERCP were randomized to undergo endoscopist-facilitated intubation or to standard intubation. Demographic data, patient/procedure characteristics, endoscopy efficiency parameters, and adverse events were analyzed. RESULTS During the study period, 45 ERCP patients were randomized to undergo either endoscopist-facilitated intubation (n = 23) or standard intubation (n = 22). Endoscopist-facilitated intubation was successful in all patients, with no hypoxic events. Median time from patient arrival in room to procedural start was shorter in patients undergoing endoscopist-facilitated intubation versus standard intubation (8.2 vs 29 minutes, P < .0001). Endoscopist-facilitated intubations were brisker than standard intubations (.63 vs 2.85 minutes, P < .0001). Patients undergoing endoscopist-facilitated intubation reported less postprocedure throat discomfort (13% vs 50%, P < .01) and fewer myalgia incidences (22% vs 73%, P < .01) than patients undergoing standard intubation. CONCLUSIONS Endoscopist-facilitated intubation was technically successful in every patient. Median endoscopist-facilitated intubation time from patient arrival in room to procedural start was 3.5-fold lower, and median endoscopist-facilitated intubation time was >4-fold lower, than for standard intubation. Endoscopist-facilitated intubation significantly enhanced endoscopy unit efficiency and minimized staff and patient injury. General adoption of this novel approach may represent a paradigm shift in the approach to safe and efficient intubation of all patients requiring general anesthesia. Although the results of this controlled trial are promising, larger studies in a broad population are needed to validate these findings. (Clinical trial registration number: NCT03879720.).
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Affiliation(s)
| | - Timothy Angelotti
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Swarnadip Ghosh
- Department of Statistics, Stanford University, Stanford, California, USA
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5
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Janik LS, Stamper S, Vender JS, Troianos CA. Pro-Con Debate: Monitored Anesthesia Care Versus General Endotracheal Anesthesia for Endoscopic Retrograde Cholangiopancreatography. Anesth Analg 2022; 134:1192-1200. [PMID: 35595693 DOI: 10.1213/ane.0000000000005851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Over the past several decades, anesthesia has experienced a significant growth in nonoperating room anesthesia. Gastrointestinal suites represent the largest volume location for off-site anesthesia procedures, which include complex endoscopy procedures like endoscopic retrograde cholangiopancreatography (ERCP). These challenging patients and procedures necessitate a shared airway and are typically performed in the prone or semiprone position on a dedicated procedural table. In this Pro-Con commentary article, the Pro side supports the use of monitored anesthesia care (MAC), citing fewer hemodynamic perturbations, decreased side effects from inhalational agents, faster cognitive recovery, and quicker procedural times leading to improved center efficiency (ie, quicker time to discharge). Meanwhile, the Con side favors general endotracheal anesthesia (GEA) to reduce the infrequent, but well-recognized, critical events due to impaired oxygenation and/or ventilation known to occur during MAC in this setting. They also argue that procedural interruptions are more frequent during MAC as anesthesia professionals need to rescue patients from apnea with various airway maneuvers. Thus, the risk of hypoxemic episodes is minimized using GEA for ERCP. Unfortunately, neither position is supported by large randomized controlled trials. The consensus opinion of the authors is that anesthesia for ERCP should be provided by a qualified anesthesia professional who weighs the risks and benefits of each technique for a given patient and clinical circumstance. This Pro-Con article highlights the many challenges anesthesia professionals face during ERCPs and encourages thoughtful, individualized anesthetic plans over knee-jerk decisions. Both sides agree that an anesthetic technique administered by a qualified anesthesia professional is favored over an endoscopist-directed sedation approach.
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Affiliation(s)
- Luke S Janik
- From the Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, Evanston, Illinois.,Department of Anesthesia & Critical Care, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Samantha Stamper
- Anesthesiology Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
| | - Jeffery S Vender
- From the Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, Evanston, Illinois.,Department of Anesthesia & Critical Care, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Christopher A Troianos
- Anesthesiology Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio
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6
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Abstract
The gastrointestinal endoscopy paradigm is rapidly changing, and technological advancements are largely responsible. In tandem, anesthesia providers are adapting to the changing needs and demands. The challenges are unique. Complications arising from the procedures are both routine, such as aspiration and hypoxia, and procedure specific, such as bleeding, pneumothorax, pneumopericardium, and pneumoperitoneum. It is crucial for the anesthesia provider to have a good understanding of the techniques employed by the endoscopist. A higher index of suspicion is also essential to diagnose and appropriately manage many of the complications. In this review, an effort is made to discuss both procedural aspects and anesthesia challenges. We hope that both endoscopists and anesthesia providers will benefit from this review.
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Affiliation(s)
- Basavana Goudra
- Department of Anesthesiology and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Monica Saumoy
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
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Thiruvenkatarajan V, Dharmalingam A, Arenas G, Wahba M, Liu WM, Zaw Y, Steiner R, Tran A, Currie J. Effect of high-flow vs. low-flow nasal plus mouthguard oxygen therapy on hypoxaemia during sedation: a multicentre randomised controlled trial. Anaesthesia 2021; 77:46-53. [PMID: 34182603 DOI: 10.1111/anae.15527] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 11/29/2022]
Abstract
Whether high-flow vs. low-flow nasal oxygen reduces hypoxaemia for sedation during endoscopic retrograde cholangiopancreatography is currently unknown. In this multicentre trial, 132 patients ASA physical status 3 or higher, BMI > 30 kg.m-2 or with known or suspected obstructive sleep apnoea were randomly allocated to high-flow nasal oxygen up to 60 l.min-1 at 100% FI O2 or low-flow nasal oxygen at 4 l.min-1 . The low-flow nasal oxygen group also received oxygen at 4 l.min-1 through an oxygenating mouthguard, totalling 8 l.min-1 . Primary outcome was hypoxaemia, defined as Sp O2 < 90% regardless of duration. Hypoxaemia occurred in 7.7% (5/65) of patients with high-flow and 9.1% (6/66) with low-flow nasal oxygen (percentage point difference -1.4%, 95%CI -10.9 to 8.0; p = 0.77). Between the groups, there were no significant differences in frequency of hypoxaemic episodes; lowest Sp O2 ; peak transcutaneous carbon dioxide; hypercarbia (transcutaneous carbon dioxide > 2.66 kPa from baseline); requirement of chin lift/jaw thrust; nasopharyngeal airway insertion; bag-mask ventilation; or tracheal intubation. Following adjustment for duration of the procedure, the primary outcome remained non-significant. In high-risk patients undergoing endoscopic retrograde cholangiopancreatography, oxygen therapy with high-flow nasal oxygen did not reduce the rate of hypoxaemia, hypercarbia or the need for airway interventions, compared with combined oral and nasal low-flow oxygen.
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Affiliation(s)
- V Thiruvenkatarajan
- Department of Anaesthesia, Queen Elizabeth Hospital, Woodville, SA, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - A Dharmalingam
- Department of Anaesthesia, John Hunter Hospital, New Lambton Heights, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callagen, NSW, Australia
| | - G Arenas
- Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, SA, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide,, SA, Australia
| | - M Wahba
- Department of Anaesthesia, Queen Elizabeth Hospital, Woodville, SA, Australia
| | - W-M Liu
- Research School of Finance, Actuarial Studies and Statistics, Australian National University, Canberra, ACT, Australia
| | - Y Zaw
- Queen Elizabeth Hospital, Woodville, SA, Australia
| | - R Steiner
- Department of Anaesthesia, Queen Elizabeth Hospital, Woodville, SA, Australia
| | - A Tran
- Royal Adelaide Hospital, Adelaide, SA, Australia
| | - J Currie
- Queen Elizabeth Hospital, Woodville, SA, Australia
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8
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Barakat MT, Angelotti TP, Banerjee S. Use of an Ultra-slim Gastroscope to Accomplish Endoscopist-Facilitated Rescue Intubation During ERCP: A Novel Approach to Enhance Patient and Staff Safety. Dig Dis Sci 2021; 66:1285-1290. [PMID: 32504349 DOI: 10.1007/s10620-020-06360-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/21/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND ERCP is often performed under monitored anesthesia care (MAC) rather than general anesthesia (GA), with patients positioned semi-prone on the fluoroscopy table. Rarely, a MAC ERCP must be converted to GA due to hypoxia or retained food in the stomach. In these circumstances, standard intubation is associated with a significant delay and potential for patient/staff injury during repositioning. We report a novel endoscopist-driven approach to intubation during ERCP using an ultra-slim, flexible gastroscope with an endotracheal tube backloaded onto it. MATERIALS AND METHODS We identified patients who underwent ERCP from 2014 to 2019, and MAC to GA conversion events. Mode of intubation (standard vs. endoscopist-facilitated) and patient/procedure characteristics were evaluated. All endoscopist-facilitated intubations were performed under anesthesiologist supervision. RESULTS A total of 3409 patients underwent ERCP; 1568 (46%) GA and 1841 (54%) MAC. Of these, 42 (2.3%) required intubation during ERCP and 16 underwent endoscopist-facilitated intubation due to retained food in the stomach and/or hypoxia. In 3 patients, aspirated material was suctioned from the trachea and bronchi using the ultra-slim gastroscope. Immediate post-procedure extubation was successful in all endoscopist-facilitated intubation patients and none exhibited radiographic evidence of aspiration pneumonia. CONCLUSIONS Endoscopist-facilitated intubation using an ultra-slim flexible gastroscope is feasible and expeditious for MAC to GA conversion during ERCP. This technique is readily accomplished in the semi-prone position, while standard intubation requires patient transfer from fluoroscopy table to gurney, with associated delay/risks. These data suggest that further study of this approach is warranted, and this may be the most favorable approach for intubation during ERCP.
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Affiliation(s)
- Monique T Barakat
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC 5244, Stanford, CA, 94305, USA.,Division of Pediatric Gastroenterology, Lucille Packard Children's Hospital at Stanford University Medical Center, Stanford, CA, 94305, USA
| | - Timothy P Angelotti
- Department of Anesthesia Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Subhas Banerjee
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, 300 Pasteur Drive, MC 5244, Stanford, CA, 94305, USA.
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9
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Goudra B, Singh PM. Anesthesia for GI endoscopy in the era of COVID-19. Saudi J Anaesth 2021; 15:27-32. [PMID: 33824639 PMCID: PMC8016064 DOI: 10.4103/sja.sja_629_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/24/2020] [Accepted: 07/01/2020] [Indexed: 11/04/2022] Open
Abstract
As a result of COVID-19, the last few weeks have necessitated a reevaluation of the sedation paradigm for gastrointestinal (GI) endoscopic procedures. Routine screening and some surveillance procedures have taken a backseat and likely to remain so until a vaccine or effective treatment becomes available. Anesthesia providers and endoscopists are required to adapt to this new reality rapidly. The general aim of sedation remains the same-patient comfort, reduced hypoxia, prevention of aspiration along with rapid recovery, and discharge. The present review focuses on necessary modification to reduce the risk of virus contagion for both patients (from health-care providers) and vice versa. A preprocedure evaluation and consenting should be modified and provided remotely. Unsedated GI endoscopy, sedation with minimal respiratory depression, and modification of general anesthesia are explored. Challenges with supplemental oxygen administration and monitoring are addressed. Guidelines for appropriate use of personal protective equipment are discussed. Measures for limiting aerosolization are deliberated.
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Affiliation(s)
- Basavana Goudra
- Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Preet Mohinder Singh
- Department of Anesthesiology, Washington University in Saint Louis, Saint Louis, MO, USA
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10
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Peck J, Nguyen ATH, Dey A, Amankwah EK, Rehman M, Wilsey M. Airway Management for Initial PEG Insertion in the Pediatric Endoscopy Unit: A Retrospective Evaluation of 168 Patients. Pediatr Gastroenterol Hepatol Nutr 2021; 24:100-108. [PMID: 33505899 PMCID: PMC7813569 DOI: 10.5223/pghn.2021.24.1.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/01/2020] [Accepted: 09/26/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Percutaneous endoscopic gastrostomy (PEG) tube placements are commonly performed pediatric endoscopic procedures. Because of underlying disease, these patients are at increased risk for airway-related complications. This study compares patient characteristics and complications following initial PEG insertion with general endotracheal anesthesia (GETA) vs. anesthesia-directed deep sedation with a natural airway (ADDS). METHODS All patients 6 months to 18 years undergoing initial PEG insertion within the endoscopy suite were considered for inclusion in this retrospective cohort study. Selection of GETA vs. ADDS was made by the anesthesia attending after discussion with the gastroenterologist. RESULTS This study included 168 patients (GETA n=38, ADDS n=130). Cohorts had similar characteristics with respect to sex, race, and weight. Compared to ADDS, GETA patients were younger (1.5 years vs. 2.9 years, p=0.04), had higher rates of severe American Society of Anesthesiologists (ASA) disease severity scores (ASA 4-5) (21% vs. 3%, p<0.001), and higher rates of cardiac comorbidities (39.5% vs. 18.5%, p=0.02). Significant associations were not observed between GETA/ADDS status and airway support, 30-day readmission, fever, or pain medication in unadjusted or adjusted models. GETA patients had significantly increased length of stay (eβ=1.55, 95% confidence interval [CI]=1.11-2.18) after adjusting for ASA class, room time, anesthesia time, fever, and cardiac diagnosis. GETA patients also had increased room time (eβ=1.20, 95% CI=1.08-1.33) and anesthesia time (eβ=1.50, 95% CI=1.30-1.74) in adjusted models. CONCLUSION Study results indicate that younger and higher risk patients are more likely to undergo GETA. Children selected for GETA experienced longer room times, anesthesia times, and hospital length of stay.
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Affiliation(s)
- Jacquelin Peck
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Anh Thy H Nguyen
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Aditi Dey
- Office of Medical Education, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Ernest K Amankwah
- Institute for Clinical and Translational Research, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Mohamed Rehman
- Pediatric Anesthesiology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Michael Wilsey
- Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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11
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Lin YJ, Wang YC, Huang HH, Huang CH, Liao MX, Lin PL. Target-controlled propofol infusion with or without bispectral index monitoring of sedation during advanced gastrointestinal endoscopy. J Gastroenterol Hepatol 2020; 35:1189-1195. [PMID: 31802534 DOI: 10.1111/jgh.14943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/11/2019] [Accepted: 11/19/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIM Target-controlled infusion (TCI) uses averaged pharmacokinetic datasets derived from population samples to automatically control the infusion rate. Bispectral index (BIS) technology non-invasively measures levels of consciousness during surgical procedures. We compared the efficacy and safety of propofol TCI with or without BIS monitoring for sedation during advanced gastrointestinal endoscopy. METHODS This prospective study enrolled 200 patients who were premedicated with midazolam 2 mg and alfentanil 0.4 mg before undergoing advanced gastrointestinal endoscopy. The initial target blood concentration of propofol was set at 1.0 μg/mL, and adjustments of 0.2 μg/mL were made as necessary to maintain moderate-to-deep sedation. Patients were randomized to either the BIS-blind group and evaluated for depth of anesthesia by monitoring scores of 1-2 on the Modified Observer's Assessment of Alertness/Sedation scale (n = 100) or to the BIS-open group and monitored by BIS scores of 60-80 (n = 100). The primary outcome was the total amount of propofol required to maintain anesthesia. Secondary outcomes were sedation-induced adverse events, recovery, and quality of sedation (endoscopist and patient satisfaction). RESULTS The mean propofol infusion rate was significantly higher in patients not monitored by BIS scores than in those who were (5.44 ± 2.12 vs 4.76 ± 1.84 mg/kg/h; P = 0.016). Levels of satisfaction were higher for endoscopists who used BIS monitoring than in those who did not. CONCLUSIONS Mean infusion rates were higher in propofol TCI without BIS monitoring compared with propofol TCI with BIS during advanced gastrointestinal endoscopy. Endoscopists expressed satisfaction with BIS monitoring.
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Affiliation(s)
- Yueh-Juh Lin
- Department of Cardiology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hui-Hsun Huang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Hsiang Huang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Xiu Liao
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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12
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Tran A, Thiruvenkatarajan V, Wahba M, Currie J, Rajbhoj A, van Wijk R, Teo E, Lorenzetti M, Ludbrook G. LMA® Gastro™ Airway for endoscopic retrograde cholangiopancreatography: a retrospective observational analysis. BMC Anesthesiol 2020; 20:113. [PMID: 32404136 PMCID: PMC7218825 DOI: 10.1186/s12871-020-01019-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/22/2020] [Indexed: 12/27/2022] Open
Abstract
Background Various airway techniques have been employed for endoscopic procedures, with an aim to optimise patient outcomes by improving airway control and preventing hypoxia whilst avoiding the need for intubation. The LMA® Gastro™ Airway, a novel dual channel supraglottic airway technique, has been described as such a device. Its utility alongside sedation with low flow nasal cannula and general anaesthesia (GA) with intubation for endoscopic retrograde cholangiopancreatography (ERCP) procedures was evaluated. Methods Details of all the ERCPs performed in our institution from March 2017 to June 2018 were carefully recorded in the patients’ electronic case records. Data on the successful completion of ERCP through LMA® Gastro™ Airway; any difficulty encountered by the gastroenterologists; and adverse events were recorded. Episodes of hypoxia (SpO2 < 92%) and haemodynamic parameters were compared across the three groups: LMA® Gastro™ vs. sedation with low flow nasal cannula vs. GA with an endotracheal tube (ETT). Results One hundred seventy-seven ERCP procedures were performed during the study period. The LMA® Gastro™ Airway was employed in 64 procedures (36%) on 59 patients. Of these 64 procedures, ERCP was successfully completed with LMA® Gastro™ Airway in 63 (98%) instances, with only one case requiring conversion to an endotracheal tube. This instance followed difficulty in negotiating the endoscope through LMA® Gastro™ Airway. No episodes of hypoxia or hypercapnia were documented in both LMA® Gastro™ and GA with ETT groups. One sedation case with nasal cannula was noted to have hypoxia. Adverse intraoperative events were recognised in 2 cases of LMA® Gastro™: one had minimal blood stained secretions from the oral cavity that resolved with suctioning; the other developed mild laryngospasm which resolved spontaneously within a few minutes. Conclusion In patients undergoing ERCP, the LMA® Gastro™ airway demonstrated a high success rate for ERCP completion. Ventilation was well maintained with minimal intraoperative and postoperative adverse events. This technique may have a role in higher risk groups such as high ASA (American Society of Anesthesiologists) status, or those with potential airway difficulties such as high body mass index and those with known or suspected sleep apnoea.
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Affiliation(s)
- Andre Tran
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Venkatesan Thiruvenkatarajan
- Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, 5011, Australia.
| | - Medhat Wahba
- Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, 5011, Australia
| | - John Currie
- Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, 5011, Australia
| | - Anand Rajbhoj
- Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, 5011, Australia
| | - Roelof van Wijk
- Department of Anaesthesia, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, 5011, Australia
| | - Edward Teo
- Department of Gastroenterology, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, Australia
| | - Mark Lorenzetti
- Department of Gastroenterology, The Queen Elizabeth Hospital, 28 Woodville Rd, Adelaide, South Australia, Australia
| | - Guy Ludbrook
- Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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Goudra B, Singh PM. Critical Analysis of Guidelines for Providing Sedation to Patients Undergoing Gastrointestinal Endoscopy Procedures. Anesth Essays Res 2019; 13:601-607. [PMID: 32009702 PMCID: PMC6937897 DOI: 10.4103/aer.aer_135_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 12/11/2022] Open
Abstract
In spite of growing numbers of gastrointestinal endoscopic procedures performed under deep sedation, guidelines are lacking. Hypoxemia and aspiration continue to be the main source of morbidity. Anesthesia providers have tried to address these concerns by modifying their technique and employing newer or improvised devices. In addition, preprocedural evaluation poses many challenges. In many centers, workload pressures determine the time available to perform such an evaluation. A comprehensive history and examination similar to a major surgical procedure is often not possible. As a result, a focused history and examination is essential. This should be followed by an appropriate explanation of risks before obtaining consent. A plan should be in place to manage complications such as aspiration. This paper provides a succinct review of the above aspects.
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Affiliation(s)
- Basavana Goudra
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Preet Mohinder Singh
- Department of Anesthesiology, Washington University in Saint Louis, St. Louis, Missouri, USA
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14
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Smith ZL, Nickel KB, Olsen MA, Vargo JJ, Kushnir VM. Type of sedation and the need for unplanned interventions during ERCP: analysis of the clinical outcomes research initiative national endoscopic database (CORI-NED). Frontline Gastroenterol 2019; 11:104-110. [PMID: 32133108 PMCID: PMC7043086 DOI: 10.1136/flgastro-2019-101175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/02/2019] [Accepted: 04/25/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND AIMS Recent studies suggest that sedation provided by anaesthesia professionals may be less protective against serious adverse events than previously believed, however, data are lacking regarding endoscopic retrograde cholangiopancreatography (ERCP). Using the clinical outcomes research initiative national endoscopic database (CORI-NED), we aimed to assess whether mode of sedation was associated with rates of unplanned interventions (UIs) during ERCP. PATIENTS AND METHODS All subjects from CORI-NED undergoing ERCP from 2004 to 2014 were identified and stratified into three groups based on the initial mode of anaesthesia: endoscopist-directed sedation (EDS), monitored anaesthesia care without an endotracheal tube (MAC-WET) and general endotracheal anaesthesia (GEA). The primary outcome was UIs. To assess the impact of sedation mode on UIs, multivariable logistic regression models were created adjusting for demographic, physician and procedure-level variables. DESIGN Population-based study. RESULTS 26 698 ERCPs were analysed (7588 EDS, 8395 MAC-WET, 10 715 GEA). UIs occurred in 320 ERCPs (1.2%). EDS was associated with a higher risk of UIs compared with sedation administered by an anaesthesia professional (OR 1.86, 95% CI 1.44 to 2.42). Additional factors associated with a higher risk of UIs included ASA class IV compared with class II (OR 3.18, 95% CI 2.00 to 5.06) and ERCPs done in community (OR 1.41, 1.04 to 1.91) and health maintenance organisations (OR 3.75, 2.01 to 6.99) hospitals. CONCLUSION EDS is associated with a higher risk of UIs during ERCP compared with sedation administered by an anaesthesia professional. Higher ASA class and procedures performed in non-university hospitals were also associated with a higher risk of UIs. This study suggests that, when available, sedation using an anaesthesia professional should be utilised for ERCP.
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Affiliation(s)
- Zachary L Smith
- Gastroenterology and Liver Disease, University Hospitals, Cleveland, Ohio, USA,Division of Gastroenterology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
| | - Katelin B Nickel
- Division of Infectious Diseases, Washington University in Saint Louis School of Medicine, Saintt Louis, MO, USA
| | - Margaret A Olsen
- Division of Infectious Diseases, Washington University in Saint Louis School of Medicine, Saintt Louis, MO, USA
| | - John J Vargo
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vladimir M Kushnir
- Division of Gastroenterology, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
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15
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Smith ZL, Mullady DK, Lang GD, Das KK, Hovis RM, Patel RS, Hollander TG, Elsner J, Ifune C, Kushnir VM. 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. Gastrointest Endosc 2019; 89:855-862. [PMID: 30217726 DOI: 10.1016/j.gie.2018.09.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/03/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS 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. METHODS 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 procedure duration, cannulation success, in-room time, and immediate adverse events. RESULTS Two hundred patients (mean age, 61.1 ± 13.6 years; 36.5% women) were randomly assigned to GEA (n = 101) or MAC (n = 99) groups. Composite SRAEs were significantly higher in the MAC group compared with the GEA group (51.5% vs 9.9%, P < .001). This was primarily driven by the frequent need for airway maneuvers in the MAC group. Additionally, ERCP was interrupted in 10.1% of patients in the MAC group to convert to GEA because of respiratory instability refractory to airway maneuvers (n = 8) or significant retained gastric contents (n = 2). There were no statistically significant differences in cannulation, in-room, procedure, or fluoroscopy times between the 2 groups. All patients undergoing GEA were successfully extubated in the procedure room at completion of ERCP, and Aldrete scores in recovery did not differ between the 2 groups. There were no immediate adverse events. CONCLUSION In patients at high risk for SRAEs undergoing ERCP, sedation with GEA is associated with a significantly lower incidence of SRAEs, without impacting procedure duration, success, recovery, or in-room time. These data suggest that GEA should be used for ERCP in patients at high risk for SRAEs (Clinical trial registration number: NCT02850887.).
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Affiliation(s)
- Zachary L Smith
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Daniel K Mullady
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Gabriel D Lang
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Koushik K Das
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Robert M Hovis
- Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Riddhi S Patel
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Thomas G Hollander
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Jeffery Elsner
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Catherine Ifune
- Department of Anesthesiology, Washington University School of Medicine, St Louis, Missouri, USA
| | - Vladimir M Kushnir
- Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA
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16
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Stone AB, Brovman EY, Greenberg P, Urman RD. A medicolegal analysis of malpractice claims involving anesthesiologists in the gastrointestinal endoscopy suite (2007–2016). J Clin Anesth 2018; 48:15-20. [DOI: 10.1016/j.jclinane.2018.04.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 04/13/2018] [Accepted: 04/15/2018] [Indexed: 11/26/2022]
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17
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Pérez Roldán F. Is the education available to anesthetists adequate to provide sedation in endoscopy units? REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:260-261. [PMID: 29620409 DOI: 10.17235/reed.2018.5515/2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It is a letter that aims to emphasize the type of sedation that is sometimes used by anesthetists to perform a standard endoscopy and the excessive use of the operating room, which increases the cost of endoscopy and reduces the resources of surgical time.
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18
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Goudra BG, Singh PM. Anesthesia for ERCP. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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19
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Goudra B, Singh PM. Airway Management During Upper GI Endoscopic Procedures: State of the Art Review. Dig Dis Sci 2017; 62:45-53. [PMID: 27838810 DOI: 10.1007/s10620-016-4375-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/03/2016] [Indexed: 12/14/2022]
Abstract
With the growing popularity of propofol mediated deep sedation for upper gastrointestinal (GI) endoscopic procedures, challenges are being felt and appreciated. Research suggests that management of the airway is anything but routine in this setting. Although many studies and meta-analyses have demonstrated the safety of propofol sedation administered by registered nurses under the supervision of gastroenterologists (likely related to the lighter degrees of sedation than those provided by anesthesia providers and is under medicolegal controversy in the United States), there is no agreement on the optimum airway management for procedures such as endoscopic retrograde cholangiopancreatography. Failure to rescue an airway at an appropriate time has led to disastrous consequences. Inability to evaluate and appreciate the risk factors for aspiration can ruin the day for both the patient and the health care providers. This review apprises the reader of various aspects of airway management relevant to the practice of sedation during upper GI endoscopy. New devices and modification of existing devices are discussed in detail. Recognizing the fact that appropriate monitoring is important for timely recognition and management of potential airway disasters, these issues are explored thoroughly.
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Affiliation(s)
- Basavana Goudra
- Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Preet Mohinder Singh
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, 110029, India
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20
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Goudra B, Singh PM. Providing Deep Sedation for Advanced Endoscopic Procedures: The Esthetics of Endoscopic Anesthetics. Dig Dis Sci 2016; 61:1426-8. [PMID: 27073071 DOI: 10.1007/s10620-016-4157-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Basavana Goudra
- Anesthesiology and Critical Care Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, 680 Dulles, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Preet Mohinder Singh
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, India
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21
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Abstract
OPINION STATEMENT Sedation practices in the endoscopy suite have changed dramatically in the decades since the introduction of routine colonoscopy and esophagogastroduodenoscopy (EGD). Patients initially received moderate sedation (or even no sedation), but now frequently receive monitored anesthesia care (MAC). This significant shift has introduced anesthesiologists to the endoscopy suite along with new sedative medications and safety concerns. Appreciating the ramifications of this change requires an understanding of sedation depth, patient selection, drug use, sedation delivery, patient monitoring, recovery from sedation, and patient outcomes. Furthermore, the changing landscape of healthcare quality and reimbursement challenges us to provide the best possible care for our patients in the most economical way possible. The endoscopy suite is a unique sedation environment, and it is the purpose of this article to review those elements that contribute to a uniquely demanding work environment.
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22
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Jensen JT, Hornslet P, Konge L, Møller AM, Vilmann P. High efficacy with deep nurse-administered propofol sedation for advanced gastroenterologic endoscopic procedures. Endosc Int Open 2016; 4:E107-11. [PMID: 26793779 PMCID: PMC4713185 DOI: 10.1055/s-0041-107899] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND STUDY AIMS Whereas data on moderate nurse-administered propofol sedation (NAPS) efficacy and safety for standard endoscopy is abundant, few reports on the use of deep sedation by endoscopy nurses during advanced endoscopy, such as Endoscopic Retrograde Cholangiopancreatography (ERCP) and Endoscopic Ultrasound (EUS) are available and potential benefits or hazards remain unclear. The aims of this study were to investigate the efficacy of intermittent deep sedation with propofol for a large cohort of advanced endoscopies and to provide data on the safety. PATIENTS AND METHODS All available data from patients sedated with intermittent deep NAPS for ERCP, EUS or double balloon enteroscopy (DBE, since the method was implemented in May 2007 through December 2012 were included for evaluation in a retrospective case-control design. RESULTS Data from 1899 patients undergoing 1899 procedures were included for evaluation. All but one procedure were completed with intermittent deep NAPS. The mean propofol dose was 397 mg (SD: 232.4) and the infusion rate was 23.9 mg/kg. The frequency of hypoxia was 4.3 % and 20 patients needed assisted ventilation (1.1 %). Anesthesiologic support was requested eight times (0.4 %). One patient was intubated due to suspected aspiration. CONCLUSIONS Intermittent deep NAPS for advanced endoscopies in selected patients provided an almost 100 % success rate. However, the rate of hypoxia, hypotension and respiratory support was high compared with previously published data, but the method was still assessed as safe.
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Affiliation(s)
- Jeppe Thue Jensen
- Gastro unit D, Department of endoscopy, Copenhagen University Hospital Herlev, Denmark
| | - Pernille Hornslet
- Gastro unit D, Department of endoscopy, Copenhagen University Hospital Herlev, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark, Denmark
| | - Ann Merete Møller
- Department of Anaesthesiology, Copenhagen University Hospital Herlev, Denmark
| | - Peter Vilmann
- Gastro unit D, Department of endoscopy, Copenhagen University Hospital Herlev, Denmark
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Goudra BG, Chandramouli M, Singh PM, Sandur V. Goudra ventilating bite block to reduce hypoxemia during endoscopic retrograde cholangiopancreatography. Saudi J Anaesth 2014; 8:299-301. [PMID: 24843353 PMCID: PMC4024697 DOI: 10.4103/1658-354x.130756] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We describe the airway management of a patient presenting for ERCP with a bite block that allows positive pressure ventilation.
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Affiliation(s)
- Basavana Gouda Goudra
- Department of Clinical Anesthesiology and Critical Care, Perelman School of Medicine, 680 Dulles Building, Philadelphia, PA 19104, USA
| | - Ms Chandramouli
- Department of Gastroenterology, Fortis Hospital, Nagarabhavi, Karnataka, India
| | - Preet Mohinder Singh
- Department of Anesthesiology and Critical Care Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Veerendra Sandur
- Department of Gastroenterology, Banneraghatta, Bengaluru, Karnataka, India
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