Conscious sedation during endoscopic retrograde cholangiopancreatography: midazolam or midazolam plus meperidine?

Background: With a rapidly aging population, the need for endoscopic retrograde cholangiopancreatography (ERCP) is increasing. The commonly used sedation anesthesia in ERCP is a combination of propofol and fentanyl, even though fentanyl may cause some adverse reactions such as respiratory depression. Objectives: This study aimed to evaluate the efficacy of oxycodone combined with propofol versus fentanyl combined with propofol for sedation anesthesia during ERCP. Methods: A total of 193 patients aged from 65 to 80 years undergoing ERCP were enrolled and randomized into two groups: an “oxycodone combined with propofol” group (group OP, n = 97) and a “fentanyl combined with propofol” group (group FP, n = 96). The rate of perioperative adverse events as well as the recovery time, patients’ satisfaction, and endoscopists’ satisfaction were noted. Results: There was no difference in the frequency of hypotension or bradycardia between the two groups, but there were more episodes of desaturation (SpO2 <90% for >10 s in 8.3%), postoperative nausea (7.3%), and vomiting (5.2%) in group FP than in group OP. Patients’ satisfaction in group FP was lower than that in group OP. The recovery time was longer in group FP than in group OP. Conclusions: Oxycodone combined with propofol was effective in ERCP, with a low incidence of perioperative adverse events.

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Dexmedetomidine versus midazolam for conscious sedation in endoscopic retrograde cholangiopancreatography: An open-label randomised controlled trial

Indian Journal of Anaesthesia ◽

10.4103/0019-5049.147191 ◽

2014 ◽

Vol 58 (6) ◽

pp. 789

Author(s):

Nidhi Arun ◽

Rajnish Kumar

Keyword(s):

Randomised Controlled Trial ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Conscious Sedation ◽

Controlled Trial ◽

Open Label ◽

Endoscopic Retrograde ◽

Randomised Controlled

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Transcutaneous monitoring of partial pressure of carbon dioxide during endoscopic retrograde cholangiopancreatography using a double‐balloon endoscope with carbon dioxide insufflation under conscious sedation

Digestive Endoscopy ◽

10.1111/den.12155 ◽

2013 ◽

Vol 26 (3) ◽

pp. 436-441 ◽

Cited By ~ 2

Author(s):

Hideaki Miyoshi ◽

Masaaki Shimatani ◽

Kota Kato ◽

Kimi Sumimoto ◽

Akiko Kurishima ◽

...

Keyword(s):

Carbon Dioxide ◽

Partial Pressure ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Conscious Sedation ◽

Carbon Dioxide Insufflation ◽

Endoscopic Retrograde ◽

Double Balloon ◽

Transcutaneous Monitoring

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Prospective Comparison of Moderate Conscious Sedation and Anesthesia Assistance for the Performance of Endoscopic Retrograde Cholangiopancreatography (ERCP)

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2021/8892085 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Ahmed Akhter ◽

Ravi Patel ◽

Eric Nelsen ◽

Mark E. Benson ◽

Deepak V. Gopal ◽

...

Keyword(s):

General Anesthesia ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Conscious Sedation ◽

Medical Center ◽

Cost Savings ◽

Success Rates ◽

Procedure Time ◽

Technical Success ◽

Endoscopic Retrograde ◽

Prospective Comparison

Objectives. Recent trends have favored the use of anesthesia personnel more frequently for advanced endoscopic procedures. We hypothesize a selective sedation approach based on patient and procedural factors using either moderate conscious sedation (MCS) or general anesthesia (GA) will result in similar outcomes and safety with significant cost savings. Methods. A 12-month prospective study of all adult endoscopic retrograde cholangiopancreatography (ERCPs) performed at a tertiary medical center was enrolled. Technical success, cannulation rates, procedural related complications, procedure time, and cost were compared between MCS and GA. Results. A total of 876 ERCPs were included in the study with 74% performed with MCS versus 26% with GA. The intended intervention was completed successfully in 95% of cases with MCS versus 96% cases with GA ( p = 0.59). Cannulation success rates with MCS were 97.5 versus 97.8% with GA ( p = 0.81). Overall, adverse event rates were similar in both groups (MCS: 6.6% vs. GA: 9.2%, p = 0.21). Mean procedure time was less for MCS versus GA, 18.3 and 26 minutes, respectively ( p < 0.0001). Selective use of MCS vs. universal sedation with GA resulted in estimated savings of $8,190 per case and $4,735,202 per annum. Conclusions. Preselection of ERCP sedation of moderate conscious sedation versus general anesthesia based upon patient risk factors and planned therapeutic intervention allows for the majority of ERCPs to be completed with MCS with similar rates of technical success and improvement in resource utilization and cost savings compared to performing ERCPs universally with anesthesia assistance.

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The burden of endoscopic retrograde cholangiopancreatography (ERCP) performed with the patient under conscious sedation

Surgical Endoscopy ◽

10.1007/s00464-012-2162-2 ◽

2012 ◽

Vol 26 (8) ◽

pp. 2213-2219 ◽

Cited By ~ 19

Author(s):

S. M. Jeurnink ◽

E. W. Steyerberg ◽

E. J. Kuipers ◽

P. D. Siersema

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Conscious Sedation ◽

Endoscopic Retrograde

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Predictive factors of oxygen desaturation of patients submitted to endoscopic retrograde cholangiopancreatography under conscious sedation

Arquivos de Gastroenterologia ◽

10.1590/s0004-28032004000300005 ◽

2004 ◽

Vol 41 (3) ◽

pp. 162-166 ◽

Cited By ~ 16

Author(s):

Suzana Müller ◽

João Carlos Prolla ◽

Ismael Maguilnik ◽

Helenice Pankowski Breyer

Keyword(s):

Endoscopic Retrograde Cholangiopancreatography ◽

Nursing Staff ◽

Predictive Factors ◽

Pulse Oximeter ◽

Conscious Sedation ◽

Oxygen Desaturation ◽

Independent Effect ◽

Close Monitoring ◽

Endoscopic Retrograde ◽

Increased Risk

BACKGROUND AND AIMS: Hypoxemia can occur during endoscopic retrograde cholangiopancreatography probably induced by the analgesia and sedation done. Moreover the patient’s prone position difficults the adequate ventilation. The hypoxemia and hypoventilation may not be noticed by nursing staff. A transversal study was used to investigate possible predictive factors of oxygen desaturation in sedated patients with midazolam associated to meperidine undergoing endoscopic retrograde cholangiopancreatography. PATIENTS AND METHODS: A total of 186 patients were monitored with continuous pulse oximetry. Poisson regression was used to measure the independent effect of each factor adjusted for effects of each of the other factors. The variables studied were: age, gender, hematocrit and hemoglobin levels, scopolamine use, diagnostic or therapeutic exam, American Society of Anesthesiologists Scores (ASA), duration time of exam, sedative used midazolam in the average of 0.07 mg/kg and analgesic drug meperidine in the average of 0.7 mg/kg that was titrated according patient’s reaction. RESULTS: No desaturation was found in 113 (60.8%) patients, mild desaturation (SpO2 <92%) in 22 (11.8%) and severe desaturation (SpO2 <90%) in 51 (27.4%). This desaturation was recognized only by the pulse oximeter. There was no need to use any antagonist drug of the sedatives in patients who had severe desaturation, they were just stimulated to deep breaths and oxygen was offered at 2 liters per minute via catheter. The variables found to predict desaturation were age >60 years old and ASA score III. The duration of exam was barely significant for desaturation. CONCLUSIONS:The variables of age of 60 years old or more, and ASA III score are identified as increased risk for desaturation for patients who undergo endoscopic retrograde cholangiopancreatography under conscious sedation. Long time of exam suggests the patient oxygen desaturate. Such patients require very close monitoring to desaturation and hypoventilation by the assistants and nursing staff alerting to respiratory depression. The use of pulse oximeter and asking for deep breaths during the exam helps to diminish such risks.

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