Division of Gastroenterology, Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA,
Dig Dis Sci. 2014 Sep;59(9):2184-90. doi: 10.1007/s10620-014-3118-2. Epub 2014 Mar 27.
General endotracheal (GET) anesthesia is often used during single-balloon enteroscopy (SBE). However, there is currently limited data regarding monitored anesthesia care (MAC) without endotracheal intubation for this procedure.
The aim of the study was to determine the safety and efficacy of MAC sedation during SBE and to identify risk factors for adverse events.
All patients who underwent SBE and SBE-assisted endoscopic retrograde cholangiopancreatography between June 2011 and July 2013 at a tertiary-care referral center were studied in a retrospective analysis of a prospectively collected database. Patients received MAC anesthesia or GET. The main outcome measurements were sedation-related adverse events, diagnostic yield, and therapeutic yield.
Of the 178 cases in the study, 166 cases (93 %) were performed with MAC and 12 (7 %) with GET. Intra-procedure sedation-related adverse events occurred in 17 % of cases. The most frequent event was transient hypotension requiring pharmacologic intervention in 11.8 % of procedures. In MAC cases, the diagnostic yield was 58.4 % and the therapeutic yield was 30.1 %. Anesthesia duration was strongly associated with the occurrence of a sedation-related adverse event (P = 0.005).
MAC is a safe and efficacious sedation approach for most patients undergoing SBE. Sedation-related complications in SBE are uncommon, but are more frequent in longer procedures.
在单气囊小肠镜检查（SBE）中，通常使用全身气管内（GET）麻醉。然而，目前关于该程序在不进行气管插管的情况下进行监测麻醉护理（MAC）的数据有限。
本研究旨在确定 MAC 镇静在 SBE 中的安全性和有效性，并确定不良事件的危险因素。
对 2011 年 6 月至 2013 年 7 月在一家三级转诊中心接受 SBE 和 SBE 辅助内镜逆行胰胆管造影的所有患者进行了回顾性分析，该分析来自于一个前瞻性收集的数据库。患者接受 MAC 麻醉或 GET。主要观察指标为镇静相关不良事件、诊断率和治疗率。
在研究的 178 例病例中，166 例（93%）采用 MAC 麻醉，12 例（7%）采用 GET。术中镇静相关不良事件发生率为 17%。最常见的事件是短暂性低血压，11.8%的手术需要药物干预。在 MAC 病例中，诊断率为 58.4%，治疗率为 30.1%。麻醉持续时间与镇静相关不良事件的发生密切相关（P=0.005）。
MAC 是大多数接受 SBE 的患者安全有效的镇静方法。SBE 中的镇静相关并发症并不常见，但在较长的手术中更为常见。
