General anaesthesia safe for ERCP in average-risk patients, finds study

Saudi Arabia: General anesthesia (GA) is safe with fewer sedation-related adverse events (SRAE) than monitored anesthesia care (MAC) in patients with ASA scores ≤3 undergoing endoscopic retrograde cholangiopancreatography (ERCP), reported an article published in the Gastrointestinal Endoscopy.

ERCP is a complex procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. ERCP procedure is very uncomfortable and so requires adequate sedation or general anesthesia for its successful termination. General anesthesia (GA) or monitored anesthesia care (MAC) is increasingly used to perform endoscopic retrograde cholangiopancreatography (ERCP). The definitive choice between the two sedative types remains to be established. ERCP is often performed in patients at high risk for sedation-related adverse events. The ASA (American Society of Anesthesiology) score is a metric to determine if someone is healthy enough to tolerate surgery and anesthesia.

Adnan Baraka A, King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia, and colleagues compared the outcome of GA with MAC in ERCP performed in patients at average risk for sedation-related adverse events.

Researchers randomly assigned 204patients (ASA class ≤3 ) to undergo ERCP with MAC or GA at a tertiary referral center. The main outcome was a composite of hypotension, arrhythmia, hypoxia, hypercapnia, apnea, and procedural interruption/termination that was defined as sedation-related adverse events (SRAE). Researchers also compared ERCP procedural time, success, and adverse events including endoscopist and patient satisfaction.