Safety and efficacy of remifentanil-propofol combination on "muscle relaxant-free" general anesthesia for therapeutic endoscopic retrograde cholangiopancreatography: a randomized controlled trial.

OBJECTIVE

To prospectively evaluate the safety and efficacy of a "muscle relaxant-free" general anesthesia using a combination of remifentanil and propofol, compared to propofol-based monitored anesthesia care and conventional general anesthesia during therapeutic endoscopic retrograde cholangiopancreatography (ERCP).

METHODS

From September to December 2019, 360 patients scheduled for elective ERCP at the Endoscopy Center of the First Affiliated Hospital of Nanjing Medical University were randomly assigned to three different groups: Group (propofol-based monitored anesthesia care, n=120), Group (general anesthesia with neuromuscular blocking agents, n=120), or Group (remifentanil-propofol combination-based muscle relaxant-free general anesthesia, n=120).

RESULTS

The results showed that there was a significant difference in intraprocedural cardiopulmonary adverse events among the three groups (Group , 37.5%; Group , 19.2%; Group , 17.5%; < 0.001). Total time (from patient entry into the Endoscopy Center to departure) and room time (from patient entry into the endoscopy suit to departure) were shorter in Group and Group compared to Group ( < 0.001). Additionally, endoscopist satisfaction levels were significantly higher in Group and Group compared to Group ( < 0.001).

CONCLUSION

The study found that administering propofol-remifentanil combination for "muscle relaxant-free" general anesthesia during therapeutic ERCP was safe and effective. This approach offered greater safety and endoscopist satisfaction than propofol-based monitored anesthesia care, as well as shorter total time and room time than conventional general anesthesia.