title: Deep sedation without intubation for ERCP is appropriate in healthier, non-obese patients.
abstract: BACKGROUND
  Providing the appropriate anesthesia for endoscopic retrograde cholangiopancreatography (ERCP) cases is challenging.
  
  
  OBJECTIVE
  The aim of our study was to prospectively assess the safety of anesthesia directed deep sedation (ADDS) in non-intubated patients compared to general endotracheal anesthesia (GET) during an ERCP.
  
  
  METHODS
  We conducted a prospective observational study in patients undergoing an ERCP. The choice of anesthetic-ADDS or GET-was made by the anesthesiologist. The pre-anesthesia assessment, intraoperative vital signs, and medications administered were collected. A standardized study instrument was used to record the number of procedure interruptions, intraprocedure and recovery room adverse events (AE).
  
  
  RESULTS
  A total of 393 (89.7 %) patients received ADDS (no intubation) and 45 (10.2 %) received a GET. Age and comorbidities were similar in ADDS and GET groups. BMI was higher in the GET (32.6 ± 9.5) versus in the ADDS (27.3 ± 6.1) group; p < 0.001. The number of ASA 2 patients was higher in the ADDS versus the GET group (38.7 versus 22.2 %; p < 0.04); the number of ASA 4 patients was 15.6 % of GET versus 6.6 % of the ADDS cases (p = 0.05). During the procedure 16 (3.7 %) ADDS patients were intubated and converted to a GET anesthetic; 4 (25 %) of the converted ADDS cases were ASA 4 versus 6.4 % of ADDS patients (p = 0.006). Intraprocedure events occurred in 35.6 % of GET and 25.7 % of ADDS cases, without significant complications.
  
  
  CONCLUSIONS
  Our data suggest that the administration of anesthesia without intubation for prone ERCP cases is feasible especially in non-obese, healthier patients.
authors.affiliation: Department of Anesthesiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA, sbarnett@bidmc.harvard.edu.
authors.forename: Sheila Ryan
authors.initials: SR
authors.lastname: Barnett
authors.forename: Tyler
authors.initials: T
authors.lastname: Berzin
authors.forename: Sirish
authors.initials: S
authors.lastname: Sanaka
authors.forename: Douglas
authors.initials: D
authors.lastname: Pleskow
authors.forename: Mandeep
authors.initials: M
authors.lastname: Sawhney
authors.forename: Ram
authors.initials: R
authors.lastname: Chuttani
mesh_terms: D000769:Anesthesia, Inhalation; D000777:Anesthetics / Q000008:administration & dosage / Q000009:adverse effects / Q000494:pharmacology*; D001835:Body Weight; D002760:Cholangiopancreatography, Endoscopic Retrograde; D054810:Deep Sedation / Q000379:methods*; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*
chemical_list: D000777:Anesthetics