Different Anesthetic Technique For ERCP
Condition: Anesthesia; Adverse Effect
Study type: Interventional

Summary: 
      Providing the appropriate anesthetic technique for endoscopic retrograde
      cholangiopancreatography (ERCP) in remote locations can be challenging. The aim of this study
      was therefore to prospectively assess and compare the feasibility of monitored anesthesia
      care (MAC) with propofol based deep sedation, standard general anesthesia and general
      anesthesia without neuromuscular blockade in patients undergoing ERCP.
    

Detailed description: 
      ERCP is identified as one of the most invasive endoscopic procedures, during which patients
      may experience anxiety, discomfort and suffer different degree of pain. So, anesthesia and
      analgesia are essential for this invasive procedure, especially therapeutic ERCPs. Thus, we
      compared the efficacy of using monitored anesthesia care (MAC) with deep sedation versus
      general anesthesia (GA) to perform this procedure and the incidence of complications
      associated with these methods of anesthesia.

      Previous studies have concluded that intubation is possible without the use of neuromuscular
      blockade. We assume that the use of propofol and adjuvants short-acting opioids may provide
      adequate conditions for tracheal intubation. It was also hypothesized that it may also be
      useful in facilitating ERCP under general anesthesia without neuromuscular blockade.
    

Intervention name(s): Monitored Anesthesia Care; General Anesthesia; Induction Without Neuromuscular Blockade
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): MAC was induced and maintained via the continuous infusion of propofol AND remifentanil using a target-controlled infusion (TCI) pump. The appropriate level of sedation was 65 to 80 points on BIS. The adjunctive sedatives (eg, fentanyl, midazolam) was at the discretion of the anesthesia team.; Induction was done with propofol (2 mg/kg) , cis-atracurium (0.15 mg/kg) , and fentanyl (5μg/kg). After orotracheal intubation, general anesthesia was maintained with sevoflurane (1-1.3MAC) , propofol (3mg/kg/h), remifentanil (0.05-0.2 ug/kg/min) and repetitive doses of 0.1mg atracurium per kilogram were administered. After the procedure was completed, neostigmine mixed with atropine was used as a reversal agent for the neuromuscular blockade, and the patient was extubated when the recovery from anesthesia was confirmed.The BIS was 45 to 60 points .; Anaesthesia was induced with propofol (2 mg/kg), remifentanil(3 ug/kg) and 2% lidocaine (1 mg/kg). Nasotracheal intubation was performed 60 s after the administration. After intubation, general anesthesia was sevoflurane (1-1.3MAC) , propofol (3mg/kg/h), remifentanil (0.05-0.2 ug/kg/min). After the procedure was completed, the patient was extubated when the recovery from anesthesia was confirmed.The BIS was 45 to 60 points .
Intervention MeSH terms: Anesthetics
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: ERCP; General anesthesia; Endoscopy; MAC