title: A prospective assessment of sedation-related adverse events and patient and endoscopist satisfaction in ERCP with anesthesiologist-administered sedation.
abstract: BACKGROUND
  Despite the increasing use of anesthesiologist-administered sedation for monitored anesthesia care (MAC) or general anesthesia in patients undergoing ERCP, limited prospective data exist on the effectiveness, safety, and cost of this approach.
  
  
  OBJECTIVE
  To prospectively assess sedation-related adverse events (SRAEs), patient- and procedure-related risk factors associated with SRAEs, and endoscopist and patient satisfaction with anesthesiologist-administered sedation.
  
  
  METHODS
  Single-center, prospective cohort study.
  
  
  METHODS
  Tertiary-care referral center.
  
  
  METHODS
  A total of 528 consecutive patients undergoing ERCP.
  
  
  METHODS
  Anesthesiologist-administered MAC or general anesthesia.
  
  
  METHODS
  SRAEs, endoscopist and patient satisfaction.
  
  
  RESULTS
  There were 120 intraprocedure SRAEs during 109 of the 528 ERCPs (21% of cases). Intraprocedure SRAEs included hypotension (38 events), arrhythmia (20 events), O(2) desaturation to less than 85% (66 events), unplanned intubation (16 events), and procedure termination (1 event). Thirty postprocedure SRAEs occurred in a total of 22 patients (4% of cases), including hypotension (5 events), endotracheal intubation (2 events), and arrhythmia (12 events). Patient-related variables associated with adverse intraprocedure events were American Society of Anesthesiologists class (P = .004) and body mass index (kg/m(2)) (P = .02). On a 10-point scale, mean endoscopist satisfaction with sedation was 9.2 (standard deviation 1.8) and patient satisfaction with sedation was 9.9 (standard deviation 0.7).
  
  
  CONCLUSIONS
  The approach to sedation was not randomized.
  
  
  CONCLUSIONS
  Higher American Society of Anesthesiologists class and body mass index are associated with an increased rate of cardiac and respiratory events during ERCP. Cardiac and respiratory events are generally minor, and MAC can be considered a safe option for most ERCP patients. Despite the frequency of minor sedation-related events, procedure interruption or premature termination was rare in the setting of anesthesiologist-administered sedation.
authors.affiliation: Division of Gastroenterology and Department of Anesthesia, Pain, and Palliative Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: Tyler M
authors.initials: TM
authors.lastname: Berzin
authors.forename: Sirish
authors.initials: S
authors.lastname: Sanaka
authors.forename: Sheila R
authors.initials: SR
authors.lastname: Barnett
authors.forename: Eswar
authors.initials: E
authors.lastname: Sundar
authors.forename: Paul S
authors.initials: PS
authors.lastname: Sepe
authors.forename: Moshe
authors.initials: M
authors.lastname: Jakubowski
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Pleskow
authors.forename: Ram
authors.initials: R
authors.lastname: Chuttani
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Sawhney
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000209:etiology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016292:Procedural Sedation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000209:etiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol