Incidence of sedation-related adverse events during ERCP with anesthesia assistance: a multicenter observational study.

Autor: Cummings LC; Division of Gastroenterology and Liver Disease, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA; Department of Medicine, Case Western Reserve University School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA., Liang C; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA., Mascha EJ; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA., Saager L; Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany; Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA., Smith ZL; Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Bhavani S; Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA., Vargo JJ; Department of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA., Cummings KC 3rd; Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA; Department of Anesthesiology, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Jazyk: angličtina
Zdroj: Gastrointestinal endoscopy [Gastrointest Endosc] 2022 Aug; Vol. 96 (2), pp. 269-281.e1. Date of Electronic Publication: 2022 Apr 04.
DOI: 10.1016/j.gie.2022.03.023
Abstrakt: Background and Aims: Anesthesia assistance is commonly used for ERCP. General anesthesia (GA) may provide greater airway protection but may lead to hypotension. We aimed to compare GA versus sedation without planned intubation (SWPI) on the incidence of hypoxemia and hypotension. We also explored risk factors for conversion from SWPI to GA.
Methods: This observational study used data from the Multicenter Perioperative Outcomes Group. Adults with American Society of Anesthesiologists physical status class I to IV undergoing ERCP between 2006 and 2019 were included. We compared GA and SWPI on incidence of hypoxemia (oxygen saturation <90% for ≥3 minutes) and hypotension (mean arterial pressure <65 mm Hg for ≥5 minutes) using joint hypothesis testing. The association between anesthetic approach and outcomes was assessed using logistic regression. The noninferiority delta for hypoxemia and hypotension was an odds ratio of 1.20. One approach was deemed better if it was noninferior on both outcomes and superior on at least 1 outcome. To explore risk factors associated with conversion from SWPI to GA, we constructed a logistic regression model.
Results: Among 61,735 cases from 42 institutions, 38,830 (63%) received GA and 22,905 (37%) received SWPI. The GA group had 1.27 times (97.5% confidence interval, 1.19-1.35) higher odds of hypotension but .71 times (97.5% confidence interval, .63-.80) lower odds of hypoxemia. Neither group was noninferior to the other on both outcomes. Conversion from SWPI to GA occurred in 6.5% of cases and was associated with baseline comorbidities and higher institutional procedure volume.
Conclusions: GA for ERCP was associated with less hypoxemia, whereas SWPI was associated with less hypotension. Neither approach was better on the combined incidence of hypotension and hypoxemia.
(Published by Elsevier Inc.)
Databáze: MEDLINE
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