Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA,
Dig Dis Sci. 2013 Nov;58(11):3287-92. doi: 10.1007/s10620-013-2783-x. Epub 2013 Jul 23.
Providing the appropriate anesthesia for endoscopic retrograde cholangiopancreatography (ERCP) cases is challenging.
The aim of our study was to prospectively assess the safety of anesthesia directed deep sedation (ADDS) in non-intubated patients compared to general endotracheal anesthesia (GET) during an ERCP.
We conducted a prospective observational study in patients undergoing an ERCP. The choice of anesthetic-ADDS or GET-was made by the anesthesiologist. The pre-anesthesia assessment, intraoperative vital signs, and medications administered were collected. A standardized study instrument was used to record the number of procedure interruptions, intraprocedure and recovery room adverse events (AE).
A total of 393 (89.7 %) patients received ADDS (no intubation) and 45 (10.2 %) received a GET. Age and comorbidities were similar in ADDS and GET groups. BMI was higher in the GET (32.6 ± 9.5) versus in the ADDS (27.3 ± 6.1) group; p < 0.001. The number of ASA 2 patients was higher in the ADDS versus the GET group (38.7 versus 22.2 %; p < 0.04); the number of ASA 4 patients was 15.6 % of GET versus 6.6 % of the ADDS cases (p = 0.05). During the procedure 16 (3.7 %) ADDS patients were intubated and converted to a GET anesthetic; 4 (25 %) of the converted ADDS cases were ASA 4 versus 6.4 % of ADDS patients (p = 0.006). Intraprocedure events occurred in 35.6 % of GET and 25.7 % of ADDS cases, without significant complications.
Our data suggest that the administration of anesthesia without intubation for prone ERCP cases is feasible especially in non-obese, healthier patients.
为内镜逆行胰胆管造影（ERCP）病例提供适当的麻醉极具挑战性。
我们的研究旨在前瞻性评估非插管患者麻醉指导下深度镇静（ADDS）与 ERCP 期间全身气管内麻醉（GET）的安全性。
我们对接受 ERCP 的患者进行了前瞻性观察性研究。麻醉医师选择麻醉方法-ADDS 或 GET。收集术前评估、术中生命体征和给予的药物。使用标准化研究工具记录手术中断次数、术中及恢复室不良事件（AE）。
共 393 例（89.7%）患者接受 ADDS（无插管），45 例（10.2%）患者接受 GET。ADDS 和 GET 组的年龄和合并症相似。GET 组的 BMI 更高（32.6 ± 9.5），ADDS 组为 27.3 ± 6.1；p < 0.001。ADDS 组的 ASA 2 患者比例高于 GET 组（38.7%比 22.2%；p < 0.04），而 ASA 4 患者比例为 GET 组的 15.6%，ADDS 组的 6.6%；p = 0.05。在手术过程中，16 例（3.7%）ADDS 患者插管并转为 GET 麻醉；转为 GET 麻醉的 16 例 ADDS 患者中，有 4 例（25%）为 ASA 4，而 ADDS 患者中仅为 6.4%；p = 0.006。GET 组和 ADDS 组术中事件分别发生 35.6%和 25.7%，无严重并发症。
我们的数据表明，对于俯卧位 ERCP 病例，不插管进行麻醉是可行的，尤其是在非肥胖、健康的患者中。
