Maiellare Federica, Sbaraglia Fabio, Del Vicario Miryam, Fattore Riccardo, Ferrone Giuliano, Lucente Monica, Piersanti Alessandra, Posa Domenico, Spinazzola Giorgia, De Padova Daniele, Malatesta Caterina, Memoli Carmela, Rossi Marco
Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00136 Rome, Italy.
J Clin Med. 2025 Aug 21;14(16):5905. doi: 10.3390/jcm14165905.
Over time, endoscopic retrograde cholangiopancreatography (ERCP) evolved into the preferred method for both diagnosing and treating diseases of the biliary, pancreatic, and ampullary systems. Traditionally performed under "conscious" sedation, anesthesiological management during ERCP increasingly involves the use of general anesthesia (GA) due to the complexity of procedures and patient comorbidities. This narrative review aims to underscore the current absence of definitive evidence supporting a single airway management strategy during ERCP. In each section, we examine the strengths and limitations of various airway management strategies, including spontaneous breathing, endotracheal intubation, and newer techniques such as high-flow nasal oxygen (HFNO) and supraglottic airway devices (SGAs), tailored for endoscopic procedures. We explore and discuss the multifactorial determinants that influence clinical decision-making, including patient-specific risk factors, procedural complexity, resource availability, and potential complications. Any anesthesiological choice must guarantee the immobility of the patient and the versatility of the position and must be integrated with the preferences and skills of the endoscopist, the available means in the endoscopic suite, and the internal protocols. Spontaneous breathing with sedation may be appropriate for low-risk, short-duration procedures but carries risks of hypoventilation and aspiration, while GA with a device to manage airways improves procedural conditions and perioperative risks. Still, it is resource-intensive and may delay recovery. Transitions between different strategies are inherently fluid, reflecting the need for a flexible, patient-centered approach tailored to the specific clinical context. Rigorous future research is essential to establish evidence-based guidelines that enhance both safety and efficiency of airway management in this setting.
随着时间的推移，内镜逆行胰胆管造影术（ERCP）已发展成为诊断和治疗胆道、胰腺及壶腹系统疾病的首选方法。传统上，ERCP是在“清醒”镇静下进行的，但由于操作的复杂性和患者的合并症，ERCP期间的麻醉管理越来越多地涉及全身麻醉（GA）。本叙述性综述旨在强调目前缺乏确凿证据支持ERCP期间单一的气道管理策略。在每一部分中，我们研究了各种气道管理策略的优缺点，包括自主呼吸、气管插管以及为内镜手术量身定制的新技术，如高流量鼻导管给氧（HFNO）和声门上气道装置（SGA）。我们探讨并讨论了影响临床决策的多因素决定因素，包括患者特定的风险因素、操作复杂性、资源可用性和潜在并发症。任何麻醉选择都必须保证患者的不动性和体位的灵活性，并且必须与内镜医师的偏好和技能、内镜检查室的可用设备以及内部协议相结合。镇静下的自主呼吸可能适用于低风险、短时间的手术，但存在通气不足和误吸的风险，而使用气道管理设备的全身麻醉可改善手术条件和围手术期风险。然而，这需要大量资源，并且可能延迟恢复。不同策略之间的转换本质上是灵活的，这反映了需要一种根据具体临床情况量身定制的、灵活的、以患者为中心的方法。未来进行严格的研究对于建立基于证据的指南至关重要，这些指南可提高这种情况下气道管理的安全性和效率。
