Hui Rex Wan-Hin, Leung Choy-May
From the Department of Medicine, the University of Hong Kong, Pokfulam, Hong Kong.
Department of Anesthesiology, Queen Mary Hospital, Pokfulam, Hong Kong.
Anesth Analg. 2022 Apr 1;134(4):765-772. doi: 10.1213/ANE.0000000000005766.
Patient-controlled sedation (PCS) has been explored as a sedation method in endoscopic retrograde cholangiopancreatography (ERCP), yet a comprehensive review article on this topic is lacking. We performed a systematic review to compare PCS against clinician-administered sedation. The primary objectives are to compare the sedative dosage used and the sedation depth, while secondary objectives are to compare sedation failure rates, clinician intervention rates, and patient satisfaction. A systematic literature search was conducted on MEDLINE, EMBASE, and the Cochrane Library Database using the terms "ERCP," "Sedation," "Patient-controlled," and related terms. Randomized controlled trials comparing PCS against clinician-administered sedation in adults undergoing ERCP were included. Articles without English full texts were excluded. Studies were reviewed by 2 independent reviewers. The Cochrane Risk of Bias tool was used for quality assessment of individual included trials. This systematic review is registered in the International Prospective Register of Systematic Reviews (CRD42020198647). A total of 2619 articles were identified from the literature search. A total of 2615 articles were excluded based on the exclusion criteria. Four articles (comprised of 4 independent trials involving 425 patients) were included in analysis. When compared with clinician-administered sedation, PCS in ERCP may lead to lower propofol dosage used and lower sedation depth. The sedation failure rates appear to be higher in PCS, whereas lower rates of airway maneuvers are required. No significant difference was observable for patient satisfaction rates between PCS and clinician-administered sedation. The included studies demonstrated unclear to high risk of bias, particularly in randomization, incomplete outcome data, and outcome measurement. PCS appears to be a feasible option for sedation in ERCP. Nonetheless, large-scale, high-quality trials will be required before PCS can be regularly implemented in ERCP.
患者自控镇静（PCS）已被探索作为内镜逆行胰胆管造影术（ERCP）中的一种镇静方法，但缺乏关于该主题的综合性综述文章。我们进行了一项系统评价，以比较PCS与临床医生实施的镇静。主要目标是比较使用的镇静剂量和镇静深度，次要目标是比较镇静失败率、临床医生干预率和患者满意度。使用术语“ERCP”、“镇静”、“患者自控”及相关术语，在医学文献数据库（MEDLINE）、荷兰医学文摘数据库（EMBASE）和考科蓝图书馆数据库中进行了系统的文献检索。纳入了比较成人ERCP中PCS与临床医生实施的镇静的随机对照试验。排除没有英文全文的文章。由2名独立评审员对研究进行审查。使用考科蓝偏倚风险工具对纳入的各个试验进行质量评估。该系统评价已在国际前瞻性系统评价注册库（注册号：CRD42020198647）中注册。通过文献检索共识别出2619篇文章。根据排除标准共排除2615篇文章。4篇文章（包括4项涉及425例患者的独立试验）纳入分析。与临床医生实施的镇静相比，ERCP中的PCS可能导致使用的丙泊酚剂量更低、镇静深度更低。PCS的镇静失败率似乎更高，而气道操作率更低。PCS与临床医生实施的镇静之间的患者满意度率没有显著差异。纳入的研究显示偏倚风险不明确至高风险，尤其是在随机化、不完整的结局数据和结局测量方面。PCS似乎是ERCP镇静的一种可行选择。尽管如此，在PCS能够在ERCP中常规实施之前，还需要进行大规模、高质量的试验。
